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CAM on campus: Homeopathy

I am quite proud of my medical school. The dedicated faculty and dynamic curriculum produce graduates of excellent clinical skill with a strong sense of service. Initially I was too focused on coursework to pay much mind to the student-run interest group in “cross-cultural and integrative medicine” and the occasional extracurricular CAM event. More recently, however, I noticed that such events had become a highly-publicized, monthly occurrence. It was still very much outside the official curriculum, but the discussion was one-sided with no public debate.

In addition to the student group on my local campus, we have a “CAM institute” that boosts CAM across the wider university. The CAM institute is a major sponsor of events organized by the student group in addition to producing its own lecture series and publications. The events hosted by either group are of two types. The first kind is an activity for med students that essentially functions as stress management: a yoga instructor leads free sessions between lectures once a week, and free herbal tea or massages are offered during final exam week. Who can complain about that? The massages are quite popular.The second kind of event is a lecture or workshop on a particular CAM modality.

Topics have included acupuncture, aromatherapy, homeopathy, naturopathy, osteopathy, and Reiki. The lecturer is a practitioner of the modality in question, sometimes an MD who “integrates” the CAM into standard practice. These lectures are publicized more widely than any type of event on campus, with color posters littering the hallways from the parking deck to the hospital cafeteria. As a rule I avoid the “hands-on” workshops with, for example, Reiki masters and craniosacral manipulators, but I have attended several lectures first out of curiosity but increasingly in frustration at the lack critical analysis. After the second time I listened to a visiting MD promote homeopathy, I was moved to publish a critique in our student newspaper and finally start a public debate. 

Campus-wide emails and posters announced for weeks the upcoming guest lecture by Dr. Larry Baskind, pediatrician and instructor for the Center for the Education and Development of Homeopathy. The title of the lecture was “Clinical Homeopathy in Medicine” and the advertisements said: 

    “Dr. Baskind will discuss basic principles of homeopathy, review cases from his practice, and suggest some useful homeopathic and herbal medicines for the upcoming cold and flu season. … Dr. Baskind has found that homeopathic (and herbal) medicines can be very effective treatments for a variety of complaints that a busy pediatrician sees in practice on a daily basis.  When knowledgeably prescribed, these medicines are inexpensive, safe to take, and beneficial to patients.”

Searching Google for Dr. Baskind, I found a video of him recommending Oscillococcinum, a homeopathic flu remedy derived from duck liver (insert quackery pun here), on the website of its manufacturer. In the promotional video, he describes Oscillococcinum as a safe, easy, over-the-counter way for parents to treat children at the first sign of flu. The viewer may be heartened to hear him stress the importance of flu vaccine and of medical treatment for flu complications. Immediately following that advice, however, he asserts (emphasis mine): ”What I find most impressive is that Oscillococcinum has been available for 65 years. … 14 million people around the world treat themselves with Oscillococcinum for the flu.” Apparently less impressive than the marketing numbers are the data he references at the end of the video, which are not accessible on PubMed and were criticized for ”suspiciously round numbers” by the Cochrane review. Appeals to age and popularity rather than decent data while glossing over the fundamental implausibility of homeopathy was a good preview of Dr. Baskind’s lecture.

The talk took place in the largest hall of the medical school, which to my dismay was filled rather more than it was for most course lectures. Hopefully, I told myself, the high attendance was due to the impressive spread of wraps and salads. (Most extracurricular lectures necessarily use pizza or subs to entice busy med students, and the CAM events can be often counted on for a free lunch of exceptional quality.) If AMSA thinks I should be “Pharm-free“, I thought, then I will be “CAM-free” to stay impartial, so I brought my own food.

The speaker was comfortable and charming before the audience. He assured us that he always follows evidence-based medicine (EBM) when possible, praising vaccines and antibiotics as proof of this commitment. However, he finds that EBM has nothing to offer for many common complaints brought by his patients, such as viral infections, and he feels compelled to do something. Therefore he looks to homeopathy to pick up the slack when EBM fails. He showed with a chart how often in a given month, according to a review of his patient records, he has no EBM recommendation for a patient’s chief complaint. (These frequencies of EBM failure were the only data presented during the hour.)

Dr. Baskind freely acknowledged, with a knowing grin, that the 200-year-old theory behind homeopathy strains credulity. He then explained all about similars and infinitesimals anyway, without suggesting any more plausible mechanism. Pointing out the problem with Avogardro’s number he all but admitted that there is no trace of the original ingredient, and yet he still claimed that the particular pill he selects for a particular symptom has a specific effect that is clinically significant. Sprinkled through his description of which remedies address which symptoms were anecdotes about happy patients. From my article in the student newspaper:

    Why does Baskind believe in homeopathy? He expresses incredulity that so many people could believe in it for so long if it were not effective, but the “old and popular” practices of bloodletting, racism, and astrology suggest that mass delusion is certainly plausible. He is comforted because FDA regulates the manufacture of homeopathic products, but of course “not contaminated with melamine” is a far cry from “proven safe and efficacious by Phase III clinic trials.” He puts great faith in reports of patients whose symptoms improve after taking homeopathic drugs, but the primary rationale for using EBM is that such uncontrolled observations cannot distinguish correlation from causation. His anecdotes are rife with possible confounding effects, such as regression to the mean or concomitant EBM therapy, so how can we know? Randomized controlled trials (RCTs) are the appropriate way to evaluate such complex interventions.

    Homeopaths often deny the power of RCTs to analyze homeopathy because homeopathy’s mechanism is mysterious. The history of scientific medicine belies this excuse. Although the value of hygiene, for example, met resistance from physicians who relied on tradition and personal experience, incontrovertible data won the day even before the germ theory of infectious diseases was available to explain them. Similarly, the famous trial showing that lemons cure scurvy saved many lives before ascorbic acid and lysyl hydroxylase were identified.

     Baskind’s claim that RCTs are ineffective because different people respond differently to homeopathy is odd because this is true for many drugs, perhaps through genetic variation in target receptors or liver enzymes. Rather, RCTs are the solution to this problem; carefully controlled studies allow us to identify which groups respond best to which interventions even if we do not understand why (e.g., particular hypertension drugs for African Americans). If his “chronic reactional modes” have validity, then Baskind can assign subjects into appropriate groups and thereby increase the power of a homeopathy study.

    Homeopathy should not be adopted into modern medicine until it meets the same standards of science-based care as other disciplines. Baskind neither showed nor referenced data for the specific efficacy of homeopathy, probably because only low-quality trials show positive effects. Given the implausible tenets of this pre-scientific philosophy, “placebo” is the null hypothesis and the burden of proof is on homeopaths. I celebrate the ICAM call for research into old and popular treatments, but such drugs should not be used on patients before good research shows them efficacious.

When the talk ended, I raised my hand to ask my question, carefully prepared in advance to challenge without sounding presumptuous or rude. (Please remember: I am a medical student confronting a lecturing physician in a packed hall.) I asked, “How do you respond to physicians who believe the effects of homeopathy are explained by placebo?” He dismissed such physicians as obviously having never tried homeopathy before. I have noticed this theme previously in CAM apologists, effectively ”you can’t knock it until you’ve tried it.” Does experiencing a possible placebo effect firsthand make a human being more objective about it? Probably not.

I spoke up again, with less grace this time since I was not prepared for his response, saying that surely we physicians and students do not each need to try every drug or intervention personally; rather we rely on collective wisdom in the form of evidence-based guidelines. Baskind responded with a story about a woman with unexplained symptoms that improved after homeopathic treatment. It seems his primary reason for using homeopathy is not “we have good evidence (or theory) that it works” but rather “we’d hate to send patients home empty handed.”

My article earned me words of thanks from a few students, those skeptical but too busy to care much. One grumbled “someone had to say it.” Only secondhand did I hear about classmates who were unhappy about the article, though no one responded to my arguments in person or in public. In fact, one particularly friendly leader of the integrative medicine group thanked me for being respectful in my disagreement and invited me to attend an upcoming presentation by a naturopath! More on that to come.

Thanks to my article I found a sympathetic professor and some likeminded students who want to invite a skeptical physician to speak on campus, either as a counterbalance to the deluge of CAM speakers or to participate in an organized debate. Any interest from SBM writers or readers in the NYC area?

Posted in: Homeopathy

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46 thoughts on “CAM on campus: Homeopathy

  1. Dr Benway says:

    “If AMSA thinks I should be “Pharm-free“, I thought, then I will be “CAM-free” to stay impartial, so I brought my own food.”

    I admire your sense of integrity, but seriously, I’d cut you slack for eating anything on a platter in a public area at a hospital.

    Dr. Fart made emeritus? Quality finger-foods will be present. Party for new MRI machine? Hello brie wheel. Some nurse’s birthday? That piece of cake is yours.

    Learning is difficult when you’re hungry.

  2. Dr Benway says:

    Oh, forgot the other thing I was gonna say:

    I consult at a residential program and am often skeptical regarding the benefit of PRN meds for behavior problems in kids. Shutting the barn door after the horse is out, regression toward the mean, crap documentation, etc. PRNs sometimes seem a means to treat staff anxiety more than anything else. So why Seroquel? Wouldn’t a homeopathic med be better?

    All those kids with viral URIs getting antibiotics for “pharyngitis” or “sinusitis.” Wouldn’t oscillocosinum serve the greater good more effectively, aside from the fact that it’s hard to spell?

    The pressure to give a tangible to a suffering patient can be compelling.

    Long story short: white lies have their place. Prescriptions isn’t that place. Too many players to keep on the same page. Not worth it.

  3. The Blind Watchmaker says:

    Thank you, Thank you, Thank you, Tim.

    I am amazed that a modern medical school would need to “bring in” a skeptical doctor to refute pseudo-scientific nonsense.

    My hospital has recently introduced an “Integrative Medicine” department to bring placebo medicine to patients who “traditional medicine has little to offer”.

    I have lots of trouble with the disingenuous message this sends to patients. We spend time trying to explain disease processes to patients so that they may understand what is going on (at least most of us do). We explain what is known and the risks and benefits of treatments. After trying to treat underlying illness, there is still evidence-based treatments for helping the symptoms of said illnesses. Why is it so popular to offer nonsense-based therapies? Why do many doctors spout science on one hand, then start spouting nonsense on the other? This is just a smoke screen to hide the fact that some doctors do not want to take the time to just listen and then to explain. If there is no answer, then admit it. Don’t lie and say we have “alternative treatments” to try.

    I am all for making people feel empowered, but not at the expense of false-hope and down-right dishonesty.

    When there are no “real” pills to give for a condition, the urge to “giv’em somethin” is still there. “Here, use this magically charged water and let’s all pretend that it helps!”

  4. Jerebear559 says:

    I fear the fact that there are medical students out there–your classmate group leader, for instance–who, after taking the MCAT and after attending and learning 4 years of rigorous and basic physical and biological sciences in undergraduate, have any inclination whatsoever that homeopathy is even possible. Tenets of homeopathy and chemistry are polar-opposite: if you believe in one, you can’t believe in another. If you think you believe in both, you are a walking mental paradox. As a matter-of-fact, I take that back. The ONLY reason someone can believe in both is if she/he is too lazy to work through the, albeit ridiculously easy, mental proof (I’m exaggerating and being emotional…just let it slide). Perhaps some homeopathists reach the fence, but then sit on it for various reasons, even in the face of a torrent of proof that should blow her/him clear to the chemical side-of-things.

    There should be a homeopathy no-tolerance policy on medical campuses. Anyone caught conducting or supporting homeopathy as a viable medical practice should be expelled.

    Of course, in a perfect world, we’d all be intelligent enough to discern how the world works (aka chemistry) from how it doesn’t (aka homeopathy), and would choose to work in framework that matches up with reality. But in a perfect world, laws restricting freedom probably wouldn’t be necessary.

    I digress.

    Please go Richard-Dawkins style on these CAM medical students, a medical rationalist’s call-to-arms, if you will.

  5. Joe says:

    Tim, thanks for an excellent post. Truly, homeopathy is the sCAM that nobody can imagine is rational. Instead, they “kkep an open mind” which has become synonymous with “ignorant.”

    David Kroll has an item, here, about his alma mater honoring a homeopath. There is also this: from an associate prof. of pharmacology at Penn State http://live.psu.edu/story/37417 “The whole basis of homeopathy is counterintuitive to everything pharmacologists have learned about drug actions. I won’t say that I buy into it 100 percent, but I won’t say that I think it’s quackery either.”

  6. weing says:

    For whatever reasons, it became unethical for physicians to prescribe placebos. I see homeopathy as a way of bypassing this ethical restriction. Instead of “Here, Mrs. Smith. Try this Obecalp for your EBM unresponsive symptoms.”, this guy is saying “Here, Mrs Smith. Try this Oscillococcinum for your EBM unresponsive symptoms.” And he gets paid extra for it.

  7. daijiyobu says:

    Speaking of AMSA, they are, truly and wholly, credulous proponents / mouthpieces / shills for naturopathic nonsense

    per http://www.amsa.org/naturopath/ :

    “naturopathic medicine is a distinct branch of medical science [...] the practice of naturopathic medicine emerges from six underlying principles of healing. These principles are ancient and are based on the objective observation of the nature of health and disease and are today also being examined in light of scientific analysis [...] naturopathic physicians (NDs) attend 4 year full-time residential medical schools and are primary care providers trained in conventional medical sciences [{science-basis claim}...principle #1 {vitalism-basis claim}] the healing power of nature (vis medicatrix naturae) [...] naturopathic medicine has as its basis the premise that the body has an innate intelligent force capable of healing itself and our duty as physicians is to support that process by stimulating that force, providing the body with essential nutrients and removing any toxic factors.”

    Of course, peel away the ‘science-labeling camouflage’ and you find that naturopathy’s centerpiece principle — HPN-VMN / vitalism — is ***in fact*** PROFOUNDLY science-ejected.

    So, when is that which is outside of science the same as that which is within science…naturopathy.

    I think AMSA’s sCAM activists need some academic disciplining, maybe as detention, wherein each student would have to read [maybe for the first time?!?!?!] medicine’s overarching ethical code, which is obligated [minimally] to honesty and scientific-integrity

    http://www.annals.org/cgi/content/full/136/3/243

    And, in connection more directly with this SBM post [welcome, BTW], ‘naturopathy’s nonsense labeled as science’ includes naturopathy’s obligatory classical homeopathy — labeled, ISYN, a “clinical science” on their North American board exam, the NPLEX.

    Shilling: [AHD, 4th ed.] “to lure (a person) into a swindle.”

    It is a noble cause: science-based medicine blogging / to hold a candle to sCAM endarkenment!

    -r.c.

  8. DarwynJackson says:

    Thanks for the awesome post. I was wondering if your medical university had any views regarding the ethical problems of promoting therapies which had not been demonstrated as effective by the established practice of clinical trials. Also, don’t we promote evaluation of new therapies by the practices taught in Epidemiology? How are your classmates able to pass class in in Pharm or BioStats, but still able to acknowledge sCAM practitioner as legitimate partners in medicine?

  9. tmac57 says:

    Great post Tim! Welcome to SBM.
    Reading your article and the above comments made me wonder if laziness on the Dr’s part may be a factor in acceptance of CAM. After all, I bet it’s a lot more work to try to find a valid answer to a patient’s difficult problem than it is to just say “what the hell, I’ll give ‘em (insert your favorite CAM here) and send them on their way!
    By the way, while my wife was receiving cancer treatment at a prominent local hospital, I saw many fliers all about that promoted CAM . It didn’t give me a very confident feeling about what was going on there.

  10. Fifi says:

    The Blind Watchmaker – “When there are no “real” pills to give for a condition, the urge to “giv’em somethin” is still there. “Here, use this magically charged water and let’s all pretend that it helps!”

    I have to question how much of this is really about soothing the doctors’ feelings and need to feel they have done “something”? Sure it’s always presented as the patient somehow being responsible or it filling the patient’s needs but, like doctors who prescribed unnecessary antibiotics to patients to please their patients even though it wasn’t in the patient’s best interest, there seems to be quite a big element of this that is about doctors’ psychological and emotional needs and not the patient’s. How much of this is really reality avoidance by doctors who should know better? How much is about avoiding a difficult conversation with a patient and wanting to please or remain “heroic” in the patient’s eyes? Apparently quite a lot if CAM is making this kind of inroads!

  11. LindaRosaRN says:

    From the patient’s perspective, it is getting harder and harder to identify EBM physicians. You can no longer just ask if the doctor/dentist uses only EBM, because the sCAMsters docs will answer in the affirmative. Next thing the skeptical patient knows, his physician is prescribing some herbal or suggesting filings be replaced.

    As for this remark, egads, tell me I didn’t see it here:

    “For whatever reasons, it became unethical for physicians to prescribe placebos. I see homeopathy as a way of bypassing this ethical restriction.”

    (A find lot of nurses say the same about Therapeutic Touch.)

    Does it need to be pointed out that prescribing placebos, among other problems, robs the patient of informed consent?

  12. Mojo says:

    Joe wrote, “There is also this: from an associate prof. of pharmacology at Penn State http://live.psu.edu/story/37417

    Note that, like Dr. Baskind, she also alludes to “you can’t knock it until you’ve tried it” in the sentence immediately after the passage you quoted:

    “Having never used it myself, I try to keep an open mind.”

    I’d have thought that a professor of pharmacology ought to be able to come to some sort of conclusion based on the literature.

  13. Harriet Hall says:

    Having never tried jumping off a bridge, does he keep an open mind? Maybe it wouldn’t really harm him.

  14. telletdl says:

    The way the preparation of homeopathic solutions is described (multiple dilutions) indicates that there is nothing left of the “active ingredient”. But I’d like to know if they really go through that process or just fill up the bottles with water. Either way, surely somebody has subjected the cures to chemical analysis – if you show a believing doctor the analysis that the solution is just water (or sugar pill), then don’t they have to accept that it is ineffective?

    I guess what I’m saying is that it seems easy enough to refute all these claims just by showing the ingredients of the snake oil.

  15. apgaylard says:

    Thanks for the post. Oscillococcinum is something of a favorite among homeopaths seeking ‘scientific’ justification. Of course in doing so they are compromising their usual cant about seeking the true similar, individualised treatment, etc. When studies of this kind of clinical homeopathy fail the approach is often denounced as not being ‘true’ homeopathy.

    I’ve had a couple of looks (here, and here) at this topic, and to say that the evidence is thin is an understatement.

    Add in a consideration of basic plausibiliy and then it’s very clear that the review is measuring noise not therapeautic signal.

  16. Dacks says:

    Good for you speaking up at the lecture like that! I wonder if there is a way for you to bring these lectures to the attention of some of your faculty members. It would be very interesting if you could get a senior faculty (or better, administrator) to attend the lecture. Then you could observe how long he or she could keep a straight face! And he or she might be moved to bring it to the attention of higher ups.

  17. Spiv says:

    Jerebear559: having been in school not all that long ago, I can tell you exactly how this happens. What you think is going on is that kids are learning, then being tested on their capacity in the given area. You’re incredibly mistaken.

    The majority of students are making sure they get their papers in, that they are acceptable, and that they know what to answer on the exams. Once the exam is gone, so is 90% of what was learned. It’s memorized data, not critical understanding of the principles involved. They want answers to the questions they will be asked, not principles that will help them come to these answers themselves.

    Obviously some situations are better than this, but I would easily say 9 out of 10 classes, 9 out of 10 students were right in line with this assertion. Those 1 in 10 classes were not passable without some real thought process thanks to a dedicated instructor, and did help to transcend the status quo.

    Point is while every chemistry student /should/ fully well recognize that a solution cut so many times would be nothing but water, you would have to press them, in the context of chemical dilution, to bring them to that point.

  18. weing says:

    LindaRosaRN,

    No, it doesn’t have to be pointed out. I just don’t know the history. I do know from speaking with the older docs, that they used to prescribe placebos.

  19. Joe says:

    @Dacks 02 Mar 2009 at 2:32 pm,

    One would hope that would be effective. However, at many institutions the senior personnel actively support quackery (quackademic medicine), you can find articles about that here. Certainly Dr. Novella strongly opposes quackery; but ‘the powers that be at Yale’ have not, so far, been impressed. Maybe if he had a few $million to donate he could get their attention.

    Many others are shruggies (as defined by Dr. Val, here). They may be opposed to quackery; but they realize active opposition is futile or, if effective, will not advance their careers.

    Additionally, one could wonder what faculty can do for the students. The students study pharmacology, what more can one do to dissuade them from believing homeopathy? They study anatomy and physiology, what more will persuade them that ‘chiropractic’ subluxations are imaginary. Don’t get me started on naturopathy, I think it surpasses homeopathy as the ultimate quackery. If med students don’t recognize the nonsense, their basic science courses are wasted on them.

  20. qetzal says:

    telletdl asked:

    [I]f you show a believing doctor the analysis that the solution is just water (or sugar pill), then don’t they have to accept that it is ineffective?

    Nope. They’ll simply respond with a great hand-waving show about water memory and molecular imprinting and quantum effects. And that’s from the more sane (less insane?) believers.

    The really wacky ones will invoke mystical energy, interactions with the patient’s belief in homeopathy, and other certifiable tripe.

  21. DevereuxBob says:

    It is discouraging to hear that this rubbish is taken seriously in an academic setting, but encouraging that you are taking them on. Go get ‘em.

  22. Bquinnk says:

    If you want to set up a table outside the meeting room to distribute literature about science-based medicine, I will provide homemade, nutritious snacks.

  23. anorak says:

    Lovely post, there and as others have mentioned, kudos for speaking up in a polite and respectful manner.

    I’m a researcher at a large UK Science and Technology university and was alarmed to discover that out sports centre were promoting acupuncture to treat allergic rhinitis, using the phrase “studies have show acupuncture to be effective…” which, if one even glances at the literature, can easily be found not to be true.

    I fired off a suitably polite yet concerned letter asking them to reconsider the wording on their adverts. It worries me that we can be teaching students medicine, physics, engineering etc, yet promoting woo within other areas of the university. I doubt they’ll do anything about it, but a bit of spleen venting always helps!

  24. nursemolly says:

    I work in an ER and I am truly amazed at how many people are disappointed to be discharged home empty-handed after their leisurely visit concerning their mild viral illness. People really expect us, at the ER, to give them something for their cold! I always blamed the attitude on a lack of education, but after reading the article and some of the postings, I wonder how many of these patients expect to receive a cure because they usually receive one at the doctor’s office. Sometimes I would like to give them a cure- lose some weight, exercise, eat properly and sleep eight hours each night- but for some reason that advice (EBM?) is considered an infringement on personal choice and recommending Oscillococcinum is a bequeathal of knowledge gleaned in Medical School.

  25. Tim Kreider says:

    Thanks everyone for the comments! A few points in response:

    The audience for these lectures is mostly first-year and second-year students. During the first two years of medical school (in my experience), most didactic encounters have no room for skepticism or critical analysis. By necessity this part of medical school is mostly about absorbing as much received wisdom as possible from trusted professors and textbooks. (Hence the recently reported outrage by Harvard students who discovered industry connections among their pharm profs.) I plan to write more about this in a future post.

    Although my campus has an active student-led CAM group, they appear very supported by a handful of faculty. It’s the faculty participation that really bothers me, not so much the enthusiastic minority of students.

    The advertising blitz is also disturbing, especially when it extends to the hospital cafeteria and pharmacy. How can our patients be expected to understand that homeopathy is (at best) controversial if the two-foot color poster presents it as perfectly valid?

    As for the placebo question: I would love to have a discussion or debate about the appropriate use of placebos in medicine; there are very interesting ethical and professional issues involved. My problem with the CAM advocates, particularly the MD homeopaths, is that they simply ignore the debate by denying they use placebos! Perhaps placebo effects are stronger if the provider believes as well… For the sake of maintaining standards, however, we professionals need to be honest with each other, even if we decide that white lies to patients can sometimes be appropriate.

  26. Dr Benway says:

    Hence the recently reported outrage by Harvard students who discovered industry connections among their pharm profs.

    LOL. How did the poor innocents imagine stuff was funded?

    The person making a claim bears the burden of proof and the cost of proof. Those who develop new drugs and new devices do the science to prove those things are safe and effective. It’s back-breaking, consuming work that might take decades.

    Anyone who imagines that a neutral party with no stake in the outcome ought to be doing drug development research needs to ride his trike around the block a couple more times.

  27. pmoran says:

    “For the sake of maintaining standards, however, we professionals need to be honest with each other, even if we decide that white lies to patients can sometimes be appropriate.”

    It should not be necessary to lie to patients (see Harriet’s views), and in any case offering a patient the option of a harmless placebo medicine is arguably a better approach to the strong, perceived “need to prescribe” that some patients provoke, than the misuse of potentially more risky pharmacologically active agents such as antidepressants, NSAIDs and antibiotics for minor complaints.

    I suspect most general practitioners and some specialists are kidding themselves in this way when they claim they don’t use placebos and/or some not well-proved treatments. Misuse of unnecessarily powerful pharmaceuticals is the worst of all worlds, doing actual harm, as well as reinforcing certain unfavorable perceptions of our profession.

    You will find that this blog has a specialist/academic slant. Of the contributors it is possible that only Harriet hase had enough experience of everyday general practice to appreciate the frequency with which EBM does not throw up any obvious treatment option for patients requesting our help. Should we be trying so hard to deny patients any small comforts they may derive from “pretend treatments” and how much does it really matter, so long as they are also getting efficacious treatments when it really matters?

    I am sure this a major reason why many doctors turn to CAM.

  28. David Gorski says:

    You will find that this blog has a specialist/academic slant. Of the contributors it is possible that only Harriet hase had enough experience of everyday general practice to appreciate the frequency with which EBM does not throw up any obvious treatment option for patients requesting our help. Should we be trying so hard to deny patients any small comforts they may derive from “pretend treatments” and how much does it really matter, so long as they are also getting efficacious treatments when it really matters?

    Perhaps you’d like to speak with Peter Lipson about the problems of applying science-based medicine in a private practice primary care environment, then, and the supposed lack of representation of general practice on this blog. He is a busy practicing internist and is not an academician, although he is affiliated with a large teaching hospital.

  29. Mark Crislip says:

    believe me, I know all too well how difficult it is to apply ebm to medicine.

    half the time I dont know what the patient has and of those who I do diagnose, often there are only a smattering of published cases to help guide therapy. Then there are the fatigue states and the chronic lyme, and Morgellons and and and

    sometimes all I have is an honest I don’t know

    It is the job of specialist to be ignorant with style.

  30. Tim Kreider says:

    That’s a useful point, the distinction between specialist and generalist. I’m sure they face different challenges in their relationships with patients. Perhaps the primary care doc can better empathize with Baskind’s frustration at having basically healthy patients who want treatment for a self-limiting condition. The PCP needs the patient not only to get well but also to feel happy enough with the encounter to return in the future with more serious problems.

    However, it appears that specialists can also believe. In 2007 we had this MD visit to lecture on homeopathy, with an emphasis on its use in treating otitis media: http://www.healthandhealingny.org/center/staff_gereau.asp
    Certified in Reiki, too. I have not yet found a CAM advocate on campus whose enthusiasm is limited to just one controversial modality.

  31. Fifi says:

    GPs often serve as translators for their patients. Often they are the first line of response/explanation regarding whether a treatment is real or quackery and why (or being put in the role of explaining that the “stop smoking, modify your diet and exercise” advice that they’ve been giving for years IS preventative medicine, dried grass Kool-Aid isn’t…though no one wants to hear “I told you so” about the consequences of their unhealthy habits, it’s a tendency of not particularly self-responsible people to want to blame someone/thing else for their lack of “wellness”). They also serve as translators for specialists. No doubt all the specialists here are particularly warm and communicative people but the reality is that often visits with specialists are short and full of hard to digest information (both emotionally and technically difficult), the patient don’t know the specialist as well as their family physician and the specialist doesn’t know the patient as well (or their context), and so on. The problem is that sCAM is trying to take over the role of the family physician (and there’s an opening for them to do so if we don’t appropriately value the work of GPs, which we don’t, and due to the current lack of GPs). One of the reasons why sCAM has been able to get support from nurses is that it values and appreciates nurses and their role in a way that institutions and many doctors don’t.

    I suspect that some specialists sometimes don’t understand or appreciate the challenges that GPs face in terms of keeping up to date with ALL of medical research (not just the research in one specialty) and their paperwork. If we think about it for a minute, I suspect we all recognize that general practice in medicine is a very different thing that being a specialist who works in a hospital (with the staff and educational support associated with working for an institution) and who is dealing with people who have been sent to see them specifically (there’s already been a narrowing of diagnostic/treatment focus). As always, being an academic is very different than working in the field too (theory vs practice – they inform each other but can be pretty divergent when real life intercedes).

  32. Joe says:

    Tim Kreider on 09 Mar 2009 at 11:00 am wrote “I have not yet found a CAM advocate on campus whose enthusiasm is limited to just one controversial modality.”

    Your observation reminds me of Bob Park’s report (in “Voodoo Science” Oxford, 2000) on a 1995 Press conference held in the US Senate office building. There were brief statements by AM proponents concerning what problem each thought was the biggest challenge for health care. Each had his/her own pet notion, as different as “magnesium deficiency” and the need for increased availability of acupuncture. Despite the disparity in their views, they all nodded in agreement with each other.

  33. Dr Benway says:

    Despite the disparity in their views, they all nodded in agreement with each other.

    Frenemies!

  34. Dr Benway says:

    daijiyobu, I just got around to your link http://www.amsa.org/naturopath

    Wow. Just… wow.

    Look at the political stuff this organization wants med students to support: anti BigPharma, pro expansion of primary care (code for inclusion of chiropracters and naturopaths as PCPs).

    Holy fark!

    Reminds me of when Scientology bought the Cult Awareness Network.

    We gotta wake the kids up somewhow.

  35. David Gorski says:

    AMSA promotes quackery. Indeed, it even runs a summer camp for woo, designed to turn its participants into CAM advocates:

    http://scienceblogs.com/insolence/2008/03/summer_school_for_woo.php

    Also, if you think that page on naturopathy was something, read this:

    http://www.amsa.org/pdf/comptherapies.pdf

  36. Dr Benway says:

    David, I looked at your .pdf prepared for the conference, “Back to Tradition and Forward to the Future.”

    Ah, Newspeak. Calling something “tradition” does not make it so.

    There’s nothing in the post-Flexner American medical tradition that has anything to do with Ayurveda. And I suspect that Ayurveda at our modern medical schools shares about as many similarities to subcontinental Ayurveda as a New Hampshire taco shares with food south of the boarder.

    Ann Schwentker, Editor and Laura Vovan, Contributing Writer, do not declare their institutional affiliations. This annoys me. I shouldn’t have to Google to find out whether these people are students, MDs, or cult members.

    Med students should learn about alt med sects, just as they should learn about parasites. So I don’t object to an overview of what’s out there, even from a credulous promoter. However, woo promotional materials really ought not bear the stamp of a medical society.

    Did the Scientologists buy AMSA like they bought CAN?

  37. Joe says:

    Dr Benway on 15 Mar 2009 at 6:56 pm wrote “… (code for inclusion of chiropracters and naturopaths as PCPs).”

    I thought DCs and NDs were already allowed, by license, to act (and, I do mean “act”) as PCPs.

    According to this item in DC http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53668 And, I thought NDs in Washington wanted limited prescribing privileges in accordance with their practice as PCPs.

  38. Dr Benway says:

    DCs and NDs are seeking primary care status for Medicare, Medicaid, National Health Service Corps, VA, and active duty military. I put some of this on my blog.

  39. Dr Benway says:

    Joe,

    I’m reposting as my comment vanished. Hope it’s not a double post.

    Looks to me like they’re seeking PCP status with federal programs, such as Medicare, Medicaid, active duty military, Tricare, Champus, National Health Service Corps.

    The Health Care Safety Net Improvement Act passed a few years ago, includes chiropractors in the National Health Service Corps’ student loan reimbursement program.

    There’s a bill now for expanding the National Health Service for primary care. No mention of chiropractors specifically that I saw.

  40. Joe says:

    Dr. Benway,

    Thanks, I understand.

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