Complementary medicine
Posted: 19 November 2014 09:37 PM   [ Ignore ]
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I have been having a discussion on another group about Dr Oz and alternative medicine.  I have heard that Dr Oz and several other respected Medical doctors are involved in organizations dealing with what they call “complementary medicine”. I don’t know how this is different from any other kind of unproven medical claims and I’m surprised to see respected medical doctors supporting it. I find this worrying. Where is the science? These doctors apparently don’t practice evidence based medicine, which I find disturbing.  Dr. Oz, for,one, is a cardiac surgeon. Is he using “alternative medicine”  in the operating theater? (I don’t have much respect for him, generally, but I am curious about how doctors practicing evidence based medicine view him).

http://www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine.html

One of the topics discussed was acupuncture, with some of the debaters claimimg it has been accepted by the medical community as safe and effective and others who deny it. I have seen no evidence that it has been accepted by respected medical boards. And most insurance won’t cover it, so I’m skeptical.

I wonder if MacGyver and MacKenzie would weigh in on this. Is “complementary medicine” AKA, alternative medicine, making inroads into the scientific medical field? Is it a good idea? Does it contradict evidence based medicine? What do you think the future holds for this phenomenon?

Also, MacKenzie, some debaters have said that acupuncture has been shown by veterinarians to “work” on animals, which would overcome the placebo effect. Have you heard this? What is your experience with acupuncture in veterinary medicine?

Thanks,

Lois

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Posted: 19 November 2014 11:13 PM   [ Ignore ]   [ # 1 ]
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LoisL - 19 November 2014 09:37 PM

I have been having a discussion on another group about Dr Oz and alternative medicine.  I have heard that Dr Oz and several other respected Medical doctors are involved in organizations dealing with what they call “complementary medicine”. I don’t know how this is different from any other kind of unproven medical claims and I’m surprised to see respected medical doctors supporting it. I find this worrying. Where is the science? These doctors apparently don’t practice evidence based medicine, which I find disturbing.  Dr. Oz, for,one, is a cardiac surgeon. Is he using “alternative medicine”  in the operating theater? (I don’t have much respect for him, generally, but I am curious about how doctors practicing evidence based medicine view him).

http://www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine.html

One of the topics discussed was acupuncture, with some of the debaters claimimg it has been accepted by the medical community as safe and effective and others who deny it. I have seen no evidence that it has been accepted by respected medical boards. And most insurance won’t cover it, so I’m skeptical.

I wonder if MacGyver and MacKenzie would weigh in on this. Is “complementary medicine” AKA, alternative medicine, making inroads into the scientific medical field? Is it a good idea? Does it contradict evidence based medicine? What do you think the future holds for this phenomenon?

Also, MacKenzie, some debaters have said that acupuncture has been shown by veterinarians to “work” on animals, which would overcome the placebo effect. Have you heard this? What is your experience with acupuncture in veterinary medicine?

Thanks,

Lois

I had a Dr. In New York that asked if I used any alternative medicines or therapies. I said “no” and asked him if he recommended them. He told me he did not, but he wanted to be aware of anything I might be doing on the side so he could include the information in my file. I knew other patients that saw him and they had the same experience. I think he took the approach that speaking discouragingly about these unproven treatments would simply mean that his patients who did use them, would not report there use to him and that that was a potential danger for drug interactions and other information that he felt he should be aware of. He would also ask if I took any supplements or vitamins for the same reason. He cautioned me about the possible problems of overdose on compounds that are not regulated by the food and drug administration.

It is true that these things are mostly total horse picky, with a few that are effective do to the placebo effect but are otherwise harmless. But there are many compounds that are not regulated because the GOP stopped that regulation in response to the industry around these things having lobbyist to secure their business model. Senator Hatch of Utah spearheaded that legislation and many of these unregulated products are made in the state of Utah.

I don’t know what has to happen to get the American public protected by its government from possible harms that can be deadly in some cases. It was a tragic mistake by the GOP lead anti-regulation lobby they are so proud of.

[ Edited: 19 November 2014 11:17 PM by Handydan ]
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Posted: 20 November 2014 10:54 AM   [ Ignore ]   [ # 2 ]
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Hi Lois,

A huge and complex topic. As you might know, I write a blog on veterinary medicine, largely trying to debunk myths about alternative therapies, and I contribute to the Science-Based Medicine blog, so this subject takes up a great deal of my time and energy. It is hard to summarize it briefly, but I’ll try to answer your specific questions, and I’ll include links to more detailed discussions.

“Complementary medicine” is really an ideological label designed to suggest that unproven or already disproven therapies can add benefits to conventional medicine. It partly replaced “alternative medicine” because promoters of that weren’t having much luck getting most people to give up scientific medicine and replace it with alternative therapies, so they decided to change their marketing to tell people they could use both. Lately, “integrative medicine” has become the most popular term, since it suggests alternative and science-based therapies are equivalent and should be treated as the same, rather than treating science-based medicine as the main therapy and other approaches as “complementary.”

None of this has anything to do with the evidence for or against particular treatments. “Complementary and Alternative Medicine” (or CAM, as it is often called for short) is a label applied to everything from valid scientific practices like regular exercise and a healthy diet, which CAM advocates like to claim are their idea, to complete voodoo like homeopathy and Reiki. The function of the label is largely to exempt individual therapies from the standards of evidence science-based medicine uses to test treatments.

As for Dr. Oz, he is widely regarded as a charlatan who has gradually drifted from legitimate medical practice to selling snake oil on TV. Most doctors who are not CAM advocates see him as an embarrassment to the profession. Here are some links to discussions of how he is viewed from a science and evidence-based perspective.

All that said, sadly the integrative medicine propaganda is having an impact on conventional medicine, and more and more mainstream doctors and medical schools are incorporating unproven therapies into their practice. The reasons for this vary from money (lots of research dollars and sales to patients/clients) to politics (encouragement from well-meaning but misguided as well as outright bought politicians) to a desire to make patients/clients happy. Some doctors really do believe in the value of these therapies despite the lack of good research evidence, of course, because after all doctors are not immune to the allure of anecdotes, cognitive biases, and other faulty reasoning that makes unproven or bogus therapies seem effective. That is as true in veterinary medicine as in human healthcare, and I actually just wrote about the issue here.

As for acupuncture, this one is complex also. There are thousands of studies on acupuncture, with all possible results. The best evidence, with the best controls for bias and error, suggest that acupuncture improves subjective symptoms like pain and nausea, but no more than well-performed fake acupuncture. That would mean it is essentially an elaborate placebo, as has been argued in a recent editorial in the journal Anesthesia & Analgesia. It clearly has biological effects when you stick needles into the body, but the balance of the evidence suggests these effects are not predictable or controllable, they are not specific to the problem being treated or the manner in which the needling is done, it doesn’t make any difference where you put the needles, and overall it is not much different biologically from stubbing your toe or getting a bunch of paper cuts. However, the ritual of acupuncture does have a strong effect on how people perceive their symptoms, so it will feel like it’s working even if it isn’t changing objectively measurable aspects of your disease. This might have some value, though it comes at the cost of letting people believe it is something more than a placebo.

For animals, however, the way the placebo effect works is quite different, and likely acupuncture is only making owners and veterinarians feel better, not the animal patients. I wrote a blog post for the JREF Swift blog on placebos in veterinary medicine recently which talks about this in detail. In brief, apparent placebo effects do occur in research studies because the effects we call “placebo effects” actually include a number of factors that make a fake therapy look like it’s working besides just people’s beliefs. However, for the most part the placebo effect in veterinary medicine works on owners and vets rather than on patients, so we end up thinking we’ve helped when really the patient’s condition is no better. This is why we have to be especially careful to be sure our therapies in vet med really work according to scientific standards. Otherwise, we face a great risk of imagining our treatments are working while our patients continue to suffer.

I hope this is helpful, Lois. Obviously, I can give you a lot more detail if you want, especially on the veterinary side of things. And you can always check out my blog for that, and the Science-Based Medicine Blog for the perspective in human medicine.

[ Edited: 20 November 2014 10:56 AM by mckenzievmd ]
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Posted: 20 November 2014 06:12 PM   [ Ignore ]   [ # 3 ]
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Dr. McKenzie, Thanks so much for your excellent reply. It is very helpful.  I have also sent you a private message.

Sorry for spelling your name wrong. I seem to get Mc and Mac wrong every time!

Lois

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Posted: 21 November 2014 08:11 AM   [ Ignore ]   [ # 4 ]
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I can’t really add much that Mckenzie hasn’t already covered here. I will second his statement that in the medical community Oz is viewed with great disdain by physicians who are strongly science oriented although I have to say there are more doctors than there should be who are taken in by the same woo as Oz. I think Mckenzie has commented on a similarly disturbing finding in veterinary medicine. While most doctors ( people or animal) recognize CAM for what it is others are true “believers” and some have simply discovered the financial benefits of offering this type of medicine to patients and clients who are into it.

For what its worth I post on a physician only forum and there is an Oz thread going on over there. I would say that 8 out of 10 posters agree with my comments that Oz is a self serving fraud while a few of the remainder believe he is doing some good despite his short comings and an occasional physician agrees with Oz’s viewpoints completely with the opinion that the rest of us are being close minded.

Unfortunately while you do need to take a large number of science courses to get into medical school there is no requirement that you actually understand why the scientific method is so important or why it is really the only valid way to discover what works and what doesn’t.

I’ve said this before. there are people who become doctors because they love science and relish the chance to use this tool to help people and there are people who want to be a doctor for any number of other reasons and only study science because they have to in order to get into medical school. Its that latter group that is often a real danger to the practice of good rational science based medicine.

[ Edited: 21 November 2014 08:48 AM by macgyver ]
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Posted: 21 November 2014 12:25 PM   [ Ignore ]   [ # 5 ]
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macgyver - 21 November 2014 08:11 AM

I can’t really add much that Mckenzie hasn’t already covered here. I will second his statement that in the medical community Oz is viewed with great disdain by physicians who are strongly science oriented although I have to say there are more doctors than there should be who are taken in by the same woo as Oz. I think Mckenzie has commented on a similarly disturbing finding in veterinary medicine. While most doctors ( people or animal) recognize CAM for what it is others are true “believers” and some have simply discovered the financial benefits of offering this type of medicine to patients and clients who are into it.

For what its worth I post on a physician only forum and there is an Oz thread going on over there. I would say that 8 out of 10 posters agree with my comments that Oz is a self serving fraud while a few of the remainder believe he is doing some good despite his short comings and an occasional physician agrees with Oz’s viewpoints completely with the opinion that the rest of us are being close minded.

Unfortunately while you do need to take a large number of science courses to get into medical school there is no requirement that you actually understand why the scientific method is so important or why it is really the only valid way to discover what works and what doesn’t.

I’ve said this before. there are people who become doctors because they love science and relish the chance to use this tool to help people and there are people who want to be a doctor for any number of other reasons and only study science because they have to in order to get into medical school. Its that latter group that is often a real danger to the practice of good rational science based medicine.

Thanks for that, Macgyver. I will send your comments to my other discussion group, as I did McKenzie’s.

Lois

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Posted: 21 November 2014 08:28 PM   [ Ignore ]   [ # 6 ]
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Complementary medicine should be that you give someone a compliment, and then they feel better.  (As in, Lois, your posts look very pretty today.)  See? Don’t you feel better?  And as a bonus, this medicine is virtually free, and has no horrific, unwanted, side effects.

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Posted: 22 November 2014 12:12 AM   [ Ignore ]   [ # 7 ]
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TimB - 21 November 2014 08:28 PM

Complementary medicine should be that you give someone a compliment, and then they feel better.  (As in, Lois, your posts look very pretty today.)  See? Don’t you feel better?  And as a bonus, this medicine is virtually free, and has no horrific, unwanted, side effects.

It’s free, too—isn’t it? wink

Lois

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