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We Have to Draw the Line Somewhere

Passive acceptance of Alternative Medicine has eroded the quality of medical care in this country. With the DSHEA of 1994 and political correctness, we have lost the reverence afforded to us in times past. Our professional knowledge is called into question as our standards deteriorate. There no longer exists a line separating proven fact from speculation. There is no border separating reality from mythology. Our colleagues treat with antibiotics and homeopathy. With beta-blockers and energy fields. Qi and narcotics.

For many years, it has seemed that I was nearly alone in my skepticism. Anytime I would bring up an alternative medicine topic, (in reality: criticize it) others in my field would have a ho-hum reaction to it. It was politically incorrect to rant about the growth of alternative medicine, the growing use of herbs, and how something should be done about it. We family and internal medicine doctors are a generally easy lot to live with. We accept patients and their faults, and it is hard to suddenly become judgmental when it comes to our colleagues. I had no idea as a resident that there was so much woo in Colorado. Specifically, I had no idea how much there was at my academic institution. This was in the late 80s, early 90s! Oh my, how things have changed, and not for the better.

I was a naïve resident in 1990, when a nurse practitioner at my residency called me about one of my patients. She wanted to help a 20 year old woman stop smoking by… wait for it….Therapeutic Touch. I was post call, and had trusted this NP as she had been with the residency for many years. I said “yes, go ahead,” not knowing what exactly it entailed. When I did have time to look into it, I was appalled. I was guilty by association. The patient never returned to me, and I don’t blame her. She must have thought I believed in magic. It turns out that the School of Nursing at the University of Colorado had to be called out by the Rocky Mountain Skeptics on their aggressive promotion and advocacy of Therapeutic Touch.


Of course, we have been cajoled, encouraged, and forced to accept alternative medicine. Several years ago, the doctors practicing alternative medicine went to the Colorado Legislature to specifically change the law regarding the practice of medicine in the State of Colorado. They were successful, of course, since it was a case of political correctness. That meant giving everyone, even quacks, equal footing under the law. The Colorado Medical Practice act now includes a provision that states:

The board shall not take disciplinary action against a licensee solely on the grounds that such licensee practices alternative medicine.

The encouragement has also come from insurance companies giving discounts or even coverage for alternative medicine. As more and more people hear of alternative medicine in a positive way, they are more apt to use it, believe in it, and encourage it in others. It is easier to just live and let live. We have been told: “Ask your patients if they use alternative medicine, supplements, etc.” It certainly is important to know what a patient is using. But by not following it with “You might not want to do that..” we passively condone it, almost expect it. The actual number of people using alternative medicine is actually quite small. It should stay that way. Many others have addressed the flawed conclusion of the prevalence of Alternative Medicine use in the NEJM seminal article of 1/28/1993. It was not true that 1/3 of people use alternative medicine. Not in 1993. Unfortunately, due to our passive acceptance, it is possibly that high now, if you include vitamins with unsubstantiated claims and herbal supplements.

It used to be easy to spot the consumer of alternative medicine. He or she had a profound connection to “earth” and “nature.” They distrusted the establishment. They are becoming the establishment. Unfortunately, their decisions are based on belief and passion, not logic or reason. That is why they are so unbending in their devotion. For the rest of the public, their initial skepticism has been eliminated by repetitive exposure. Most people can remember a time that false advertising was rare. Our FTC and FDA had regulations and resources to combat the fraudulent. Most people don’t have a clue about DSHEA of 1994. It was safe in the 70s and 80s to see a television ad and trust that the claims have been validated. Now the supplement companies make millions of dollars before any complaint gets investigated, and those that get caught, pay a miniscule fraction of their profit in fines.

Some of those earthy people became physicians. They continue their reverence for natural, organic and unproven therapies. They have a golden opportunity to excel in the post DSHEA era. We other physicians are taught to be politically correct, and simply tolerate them. They are, unfortunately, leaders of the dumbing down of the public. We other physicians let our hospitals open Alternative and Integrative Centers without so much as a peep of disagreement. There exists a critical mass in this transformation. When enough physicians accept and advocate for unproven therapies, we have lost our direction. Our thought leaders will be replaced by politically savvy, scientifically suspect people who advance their own agenda. I, for one, want to trust that my father’s physician spent his or her continuing medical education time and money on stroke, heart attack and cancer knowledge, not herbs, acupuncture and energy medicine.

Posted in: Politics and Regulation, Science and Medicine

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43 thoughts on “We Have to Draw the Line Somewhere

  1. Thank you so much, Dr. Hansen. Finally, an article that clearly states the problem and points out the first step needed to correct it. I am amazed how even here so few let supplement advocates go unchallenged when they make erroneous statements like: there are lots of studies showing they work; we all know they are safe; go look for the studies yourself; oh, the study showed it doesn’t work; the study was bad or it used the wrong product; of course that product is bad but I don’t consider it a dietary supplement even if the law does.

    For starters, a few studies don’t count. You need a large body of good studies with consistently reproducible results done on a standardized product to draw a conclusion about efficacy and you need toxicology studies to determine safety. When weighing benefits against risks long term safety has to be compared to long term benefits and guess what, it takes a long time to get those results.

    The person making the claim is the one who must present the evidence. It is not up to anyone else to prove that he is wrong, most certainly not the consumer.

    There is a difference between nutrients and drugs and the kind of studies required to evaluate each. Supplement advocates simply can’t have it both ways. The kind of studies used to evaluate nutrients are no where near as rigorous as those required by drugs.

    These are things the general public has to be told repeatedly since for years the dietary supplement marketing machine has been telling them the opposite. The supplement industry is not about health. It is about money and should not be permited to get away with fraud in advertising.

    I think if you take a close look you will see that almost all of alt. med. is funded by the sale of supplements. I would guess that supplements make up most or a very large share of alt. practitioners incomes. It is the foundation that the building is built on and it is time that scientists and consumer advocates recognized that and scrutinized the billion $$$ supplement industry.

    For starters, how about a law that those who recommend products to patients they see cannot sell them to them?

  2. Zetetic says:

    Believing (and that’s what you have to do) in “Therapeutic Touch” and its close cousin “Healing Touch” are nothing but the “The Emperor’s New Clothes” story – Déjà vu all over again. A child debunked the delusional perception in both cases! Working in and close to nursing for decades, I’ve encountered dozens of RNs who enthusiastically promote the practice. I honestly feel that the nursing profession has fallen into this anti-science and pseudo-science trap in their attempt to create for themselves a separate and distinct professional identity from other health care providers. It’s very disconcerting to me that these fellow providers who we work with and depend upon to help deliver efficacious care can so easily gravitate to the “dark side” of alternative medicine practicies.

  3. weing says:

    MDs do it too. I’ve seen doctors adopt SCAM and they make more money as a result. Look at Andrew Weil. Some people want voodoo and witchdoctors. I blame our education system. Science is much more fascinating than any of that crap. That is not conveyed to the kids and you get a scientifically illiterate generation voting on policy decisions.

  4. Harriet Hall says:

    Rose Shapiro, a British journalist, has written a great book entitled “Suckers: How Alternative Medicine Makes Fools of Us All.”

    She explains that “suckers” has 2 meanings:
    1. The gullible
    2. Those who live at the expense of others

    And “fools” refers to
    1. Those who use alternative medicine
    2. Those who practice it
    3. The rest of us who let it carry on unchallenged.

    Dr. Hansen is right. We should speak up and challenge the idea that there is any “science” behind something like Therapeutic Touch. We should challenge the poor quality “evidence” that is presented for various forms of alternative medicine (as R. Barker Bausell does in his book “Snake Oil Science”). And we can do this without denying the placebo benefits to people who still choose to use irrational treatments. I read somewhere that telling people a treatment is only placebo doesn’t diminish the placebo effect – I haven’t been able to track down the original study, but I have observed the phenomenon anecdotally.

  5. Wallace Sampson says:

    And another kudo from here. Excellent sumary of an intolerable situation.
    Before the current level was obtained, there was a lesser current running through society, and it had been there for centuries of course.
    The difference is the money, which promoters finally figured was the key. They got smart and invested more of their earnings in promotion and political contributions. Take off a few months and try to get every Colorado legislator’s contribution list for three years prior to the law passage.
    The same thing happened in California in the late ’70s – early ’80s when Laetrile advocates and producers contributed more money to Calif.legislators’ campaigns than had ever occurred before. No one added it up, and it was a best kept secret except from our lobbyist informants.
    Again in 2002 a Hollywood producer’s $1million in contributions to Bastyr U. enabled naturopaths to lobby the legislature for licensure, and passage of a modified “Access to Medical Treatment Act.” No one knows how much the former Senate Pres. pro tem made from that score.
    Federal funding for “CAM” research already exceeds $1billion, painting a patina of legitimacy over the rot of “CAM” relativistic thinking.
    We have a long way to go to get back to 1950s levels of irrationality.

  6. Nurses are not only practicing TT. They are deeply into herbalism and often with the blessing or indifference of formerly reputable scientific institutions. I truly fear ever being incapacitated and alone at night in a hospital in the care of one of these idiots especially after attending a talk by one of the LPNs I know and hearing of the little experiments they’ve tried on patients.

    The herbalist Rosemary Gladstar lectured at my local hospital. Many of her devotees were nurses. When I found out, I asked permission to also give a talk. My request was denied. I posted the relevant correspondence here, http://homepages.together.net/~rjstan/WellnessCenter.html
    along with a letter I wrote to the local papers.

    Then I learned that Gladstar was giving lectures for continuing ed. credit to nurses at the hospital associated with Dartmouth Med. School. I wrote a letter to the MD/President of the hospital. In his response he said, “..this program is co-sponsored by the Center for Continuing Education in the Health Sciences and the Hematology-Oncology Unit here at Dartmouth-Hitchcock Medical Center. It is my understanding that programs such as these are informatinal in nature for those that choose to attend.”

    The nurse in charge who I spoke with actually believed Gladstar is an expert on botanical drugs.

    What follows are a few quotes from Gladstar’s book “Herbal Healing For Women”. There are more on my webpage at the link above if you scroll to the bottom.

    QUOTE:
    There are several exercises I love to do with students to help them develop their intuitive skills with plants. I believe that this kind of information is as valuable, if not more so, than all the book learning and educating we do. One of my favorite exercises is very simple, but so profound. Go for a walk. Find a tree that beckons to you. Put your arms around it and hug tightly. Pull yourself close to the tree and allow yourself to smell it, feel it, hear its heartbeat. Trees have very strong energy and you will feel as if you are well supported, that you can surrender and let go. Often people feel they can tell the tree anything and it will hear them and help them. Trees also have strong voices and it is easy to hear them singing back to you. When you walk into a woods, have you ever thought you heard the trees talking? They probably were! p.27&28

    I think herbs act in a particularly impressive way on women’s health because there’s a natural affinity between women and the plant world… They seem to heal on a cellular level. p.23

  7. daedalus2u says:

    There is nothing wrong with “political correctness” where it is appropriate, that would be for things political. It is wrong to use it in non-political areas and especially wrong to use it where it is important that our thinking corresponds to reality.

    In other words it is important that we all agree on the same facts about reality. It is not being “politically correct” to accept someone’s delusional notion about reality, it is being wrong, condescending and if there is a duty of care (as in a physician-patient relationship or in a political leader-citizen relationship) it is being abusive (but this can be tricky). People may legitimately derive different political outcomes from the same facts. Those political outcomes may (or may not) deserve the respect that political correctness sometimes affords them. People who compromise their understanding of reality to achieve political harmony do not have an understanding of reality that is reliable enough to be trusted.

    I have a question for the Colorado Legislature. How is the board supposed to regulate those who practice alternative medicine badly? It isn’t like the Wizard of Oz where the Good Witches are all beautiful and wear white lacey dresses and the Bad Witches are all ugly and wear black rags.

  8. Zetetic says:

    It’s interesting to note, in my observations, that when an RN gets deep into CAM, it’s not likely to be for monetary gain. It has more of the earmarks of a pseudo-religious/philosophical involvement.

  9. BlazingDragon says:

    One little quibble. Doctors are not infallible. This post makes it sound like doctors ALWAYS know best, and they don’t. Period. Anyone who says otherwise is an idiot.

    Doctors are far more educated than the lay public about medical matters, but human physiology is so complex that there will always be oddball cases. The sheer arrogance in the first paragraph makes me mad.

    Why won’t doctors believe patients when they report “weird” (i.e. rare) symptoms/medication reactions? Doctors force a lot of people into quack-based medicine because they poo-poo (or outright mock) patients who report stuff that is well outside “population averages.”

    This is the danger in sticking slavishly to medical journal articles. Patients usually don’t fit the study criteria, so what is published in peer reviewed articles may or may not apply to an individual patient. Yet nearly every doctor I have ever met gets their hackles up when a patient tells them that their treatment isn’t working. Why?

    Yes I know there are patients who are scamming for drugs to supply a drug habit. Yes I know there are patients who will never be satisfied, no matter what the doctor does. But those are relative rarities. Most of the “difficult” patients were born that way and all the “wishful thinking” or “ignoring what the patient says” on the part of the doctor will not change that. The doctor has to realize that peer-reviewed articles are a starting point, and they will HAVE to try unorthodox combinations of medications for certain patients.

    And to cut off any criticism, I am deeply opposed to CAM quackery. When I say “unorthodox,” I mean drugs that are FDA approved, but not often used. I do NOT mean herbal/reiki/touch therapy, etc.

    P.S. This post was made all the more acute for me because I have been having horrible trouble with pain control after a tonsillectomy (at age 37). The only thing that works well is toradol (which I had to stop taking after two weeks due to stomach pains and acid reflux). All the opiates in the world did little more than dull the edge of my pain. I’m really pissed off after being essentially un-medicated for pain for four out of every six hours for the first two weeks post-op. You try nearly blacking-out from pain and then tell me I should just listen to the peer-reviewed articles and respond appropriately to opiates.

  10. Zetetic in my observations when nurses get deeply into CAM it is because they want to practice medicine. The want to be doctors or “healers”. It almost seems as if they have learned the rituals but have failed to comprehend the reasons. Of course not all nurses are like this. There are many nurses who are highly competent professionals who do understand and practice evidence based medicine. How they endure the others is beyond me.

    But the thing that I think is very important to understand is that CAM didn’t just go from being a fringe practice and belief system to a multibillion $$ business preached and practiced in scientific institutions and used by a large % of the mainstream market all by itself. Very good business minds noticed the fringe beliefs and the changing attitudes of society and understood how with some savvy marketing they could turn those fringe beliefs into an oil well and become very rich. They could do that by getting everyone into the game of selling supplements and lobbying for the right to do it.

    Some sell and lobby because the marketers make them feel like pharmacologists and MDs. See, he has his pills. I have my pills. He knows how his work. I know how mine work. He cures cancer. I cure cancer. Some of the people marketers hook have serious problems with the “establishment” and anyone in authority. Others want to make a little money on the side or a lot of money, a good living. Others hear an anecdote, try the nostrum and decide, Hey it worked for me!

    The marketers have brought them all together for one reason, to make money for the companies they own or work for. They’ve done a very good job and they’ve done it by watering down the outrageous claims of the fringe groups they started with so that the claims sound rational to intelligent, reasonable people who don’t know the facts. A homeopathic product isn’t called well shaken water. It is called a “remedy” and sold right next to the OTCs in the drugstore. Most consumers think it is just another OTC. They take it. Their cold gets better. They think it worked.

    Supplement marketers throw out what appear to laymen to be scientific studies supporting their claims. They call scientists and MDs arrogant, uncaring white male bigots. Those are marketing techniques that intimidate a lot of good scientists and fool a lot of otherwise rational, intelligent consumers. That is what concerned scientists, practitioners and consumer advocates have to understand and they have to start yelling back. It isn’t about woo. It is about fraud and making a billion $$$s.

  11. Harriet Hall says:

    Blazing Dragon said, “Doctors are not infallible. This post makes it sound like doctors ALWAYS know best, and they don’t.” “what is published in peer reviewed articles may or may not apply to an individual patient.”

    You are reading something into the post that isn’t there. No one has ever suggested doctors are infallible. No one has ever suggested doctors always know best. All we have suggested is that science is better than any other method of determining the truth. It is precisely science that has taught us about individual variation and the complexity of human physiology.

    When a pain medicine fails to work for an individual patient or when a patient has an idiosyncratic reaction to a medication, a good doctor doesn’t say “That’s impossible because I read a study.” Neither does a good doctor say, “Let’s try homeopathy or therapeutic touch.” A good doctor stays within the scientific paradigm and tries to figure out how to help the patient.

  12. daedalus2u says:

    When people bring up the non-omniscience of doctors and scientists I am always reminded of the scene from the Star Trek movie “The Voyage Home”.

    Kirk: Mr. Spock, have you accounted for the variable mass of whales and water in your time re-entry program?
    Spock: Mr. Scott cannot give me exact figures, Admiral, so… I will make a guess.
    Kirk: A guess? You, Spock? That’s extraordinary.
    Spock: [to McCoy] I don’t think he understands.
    McCoy: No, Spock. He means that he feels safer about your guesses than most other people’s facts.
    Spock: Then you’re saying… it is a compliment?
    McCoy: It is.
    Spock: Ah. Then I will try to make the best guess I can.

    Some people’s guesses are better than other people’s so called “facts”.

  13. BlazingDragon says:

    Dr. Hall, with all due respect, in my long experience with the medical system, you are leaving out a third option: Tell the patient that the treatment IS working and it’s their own damned fault (psychosomatic, etc.) that they don’t perceive that it is working.

    It happens a LOT. Either they are too inexperienced or too egotistical, but they simply cannot comprehend that their “expert opinion” is wrong. Or at least they won’t admit it to the patient.

    I am going to read up on how the patient pain bill of rights was passed into practice, but if I remember correctly, it was because patients got out of the hospital faster when they weren’t hurting. People heal faster when they can damned well sleep (or at least sleep better). Yet my doctor has thrown all this out the window and declared (with no friggin’ evidence) that I don’t hurt that much any more. How unscientific and stupid is that?

    The doctors that write for this blog are the cream of the crop. I don’t think any one of you would do something like this to a patient, and because people who agree on how to treat patients tend become friends, I’m guessing you have very little contact with the large (decent minority of doctors I would guess, if not a small majority) who just follow what they learned in med school and what the pharma rep told them blindly. Or they have come to some conclusion based on the patients in their practice, but haven’t bothered to fact-check themselves and see if there is not another confounding variable.

    A lot of doctors freeze when the first and second things they try don’t work. Then when the patient asks for a third option, they often get annoyed/mad with the patient. That is what is going on here. And being the Memorial Day weekend, I’m just going to have to go home and suffer because there is no way in hell I could get an appointment with a pain specialist until Tuesday, when this will hopefully be all moot.

    And you’re right, it wasn’t directly in the post, but the arrogance displayed in the post is responsible for situations like mine. If I wasn’t so damned rational, I’d have gone over to CAM a long time ago because modern, scientific medicine simply doesn’t work for me a lot of the time. All I’m asking for is a doctor who will take the time to figure out a scientifically-based method for dealing with me, instead of blowing me off and telling me to stuff it. But I have yet to get that.

  14. BlazingDragon says:

    Oh and I forgot a 4th option: Shrug your shoulders and say “I dunno, maybe if you ask another doctor.”

    If you don’t believe this happens, you must operate in a very different world than mine, medically speaking. It’s a world I have been looking for for 15 years. I wish I could join it.

  15. pmoran says:

    I think I know what BlazingDragon means.

    Yes, as recent posts propose, portions of “alternative” medicine set themselves up in opposition to much that we prize in medicine, such as rationality and a mostly seamless integration with science and technology. (I seriously doubt that they are as much of a threat to these as some suggest.)

    But AM is also in part a reasonably rational societal response to the fact that scientific medicine has not yet found simple, entirely safe and 100% reliable answers to all of mankind’s ills and discomforts, despite the arousal of very high expectations.

    I don’t mean to imply that AM has any important answers, although I fear Nature has played a mean trick on the medical sceptic by making “how people feel” behave according to its own perverse rules, wherein fraud and lies and collusion with unfounded scientific beliefs can look, and even within limitations, act like good medicine for some.

  16. Harriet Hall says:

    BlazingDragon,

    What would you do if you were a doctor confronted with a patient such as yourself? Of course, you would take the complaints seriously and you would believe the patient was in pain, but then what would you do? This is a real dilemma, and I’m wondering if your experiences have given you insights that might help us in similar cases.

  17. DLC says:

    Hmm… Choices, choices. seek healing from somebody who will point their finger at me, rub my feet or wave herbs under my nose, all based on anecdotes, wishful thinking and touchy-feely nonsense, or seek healing from someone who has been trained in methods scientifically proven to work more than they fail.
    I think I’ll go with medicine proven to be effective.

    For blazingdragon: (and anyone else) If you believe that your doctor is wrong in his diagnosis or treatment or therapy plan, please do seek a second (or even a third!) opinion.
    Sometimes a possibility missed by one physician will be picked up by another.

  18. weing says:

    If a patient is not responding to the treatment as expected, the most common reason is that the diagnosis is wrong and I have to re-assess.

  19. durvit says:

    Dr Hall, are you referring to this?

    Park LC, Covi L. Nonblind Placebo Trial: an exploration of neurotic patients’ responses to placebo when its intert content is disclosed. Arch Gen Psychiatry. 1965 Apr;12:36-45.

  20. durvit says:

    Margaret Talbot wrote a fine article on The Placebo Prescription for the NYT in 2000. Talbot refers to Professor Walter Brown’s proposed script for research into placebo and mild depression/pain/asthma/hypertension which is closely modelled on the script used in Park and Covi.

    Brown, who thinks such a strategy would be appropriate for conditions like mild to moderate depression, pain, asthma and hypertension, in which a placebo has shown to be especially potent and in which distress plays an aggravating role, imagines the doctor saying something like this: ”Mrs. Jones, the type of depression you have has been treated in the past with either antidepressant medicine or psychotherapy, one of the talking therapies. These two treatments are still widely used and are options for you. There is a third kind of treatment, less expensive for you and less likely to cause side effects, which also helps many people with your condition. This treatment involves taking one of these pills twice a day and coming to our office every two weeks to let us know how you’re doing. These pills do not contain any drug. We don’t know exactly how they work; they may trigger or stimulate the body’s own healing processes. We do know that your chances of improving with this treatment are quite good. If after six weeks of this treatment you’re not feeling better we can try one of the other treatments.”

  21. Harriet Hall says:

    Durvit,

    Thanks for the great articles!

    This adds some ammunition to my idea that we could tell patients “There is no scientific evidence that this CAM modality works any better than placebo, but some people seem to think it helps them, and if you want to try it, I won’t object.”

    We CAN use placebos without lying!

  22. pmoran says:

    Park LC, Covi L. Nonblind Placebo Trial: an exploration of neurotic patients’ responses to placebo when its intert content is disclosed. Arch Gen Psychiatry. 1965 Apr;12:36-45.

    Be aware, if you read this, that back then placebo responsiveness was regarded as a neurotic trait. Beecher had said as much in his seminal 1955 article “The Powerful Placebo”.

    I don’t think anyone thinks so today. Many unfortunately still take offence at any suggestion that they may have responded to a placebo-type treatment. One placebo researcher claimed that he can induce a placebo response in anyone.

  23. Nyx says:

    I am a biologist, not a medical professional, and I have always had a scientific mind. It was a bit of a family joke when I was small, but I grew into it. I naively believed that medicine was a scientific endeavor. I believed that doctors practiced medicine using logical reasoning and the scientific method. That is, he or she would take the patient’s history, make an examination for baseline information, propose a preliminary diagnosis (the hypothesis). He would then make further examination and/or diagnostic tests; and, if the test results did not support the diagnosis, he would repeat the process with a new or amended diagnosis based on the additional information. When a reasonable diagnosis was reached based on the findings, he would discuss with the patient treatment options based on clinical evidence and the doctor’s experience. I reasonably expected that an experienced doctor would be able to narrow this process down, a less experienced practitioner may take more time with more procedure. I also reasonably understood that a diagnosis may not be concrete, that is based on very clear evidence, in which case the doctor’s intuitions must be brought into play. But I did expect, that as a scientist, a doctor would have intuitions that would be rationally and logically based. I repeat, I was naïve.

    A year ago I began to have gynecological problems. As the OB-GYN who previously took care of my general needs had moved out of the state, I was forced into the position of finding a new doctor and very quickly. I tried four different OB-GYN specialists over a period of six months. Doc #1 said, “There is nothing physically wrong, but you are depressed. Here are some samples and a script for an antidepressant.” I walked out on him.

    Doc #2, without even making an examination or ordering a single test, insisted that what I needed was a certain drug. When I questioned her on how she came to her conclusion, and that I would like to address a different option, (the delivery of said drug was not such that you could just stop it if it did not work, or if it caused side effects or a worsening of symptoms), she shot back that “she did not have time for my fussing and most women just do as they are told because they want to feel better.” I walked out on her as well.

    Doc #3 was even better. He insisted that symptoms were caused by PTSD due to sexual abuse, and the reason I do not recall said abuse was because I had repressed the memories. He wanted to treat me with a dozen trigger point injections! I did not just walk out on this guy, I ran like hell.

    When I showed up at Doc #4’s office, I was in a great deal of pain, so swollen I could not wear my regular clothes, and running a temp of 39C. She merely shook her head at me, said there was nothing she could do and suggested that “I see an acupuncturist.” Pardon me?

    All four of these, ahem, doctors were working in traditional clinical settings. Two were practicing in medium sized women’s clinics with hospital associations, and one was a professor of medicine, retired from teaching but still practicing at the university clinic. For the curious, I ended up in the ER with serious pain the weekend after seeing Doc #4. It was an ovarian cyst (which was missed by two of the doctors in the ultrasounds they gave me.) They recommended that I go back to my gynecologist to have the situation monitored. Yeah, right, OK.

    I agree with a prior post that many people, when faced with the hostile and often incompetent way medicine is practiced, resort to CAM out of frustration. They are not so much turning to alternatives with prior thought and belief, but are fleeing from the antagonistic environment of current medical practice. No, I am not likely to be one of those turning to CAM, but I am not likely to go a traditional clinic anytime soon either. I am of the opinion that what patients receive at CAM clinics is primarily old-fashioned TLC. And we should not underestimate or undervalue the therapeutic effect of basic compassion and empathy. In fact, if compassion, and the simple art of listening, were added back to the delivery of medicine, maybe patients will not be forced elsewhere.

  24. Nyx, where do you live so that we can avoid the place?

    Just because there are bad practitioners doesn’t mean that medicine is not a “scientific endeavor”. You have to find those practicing evidence based medicine who you are also comfortable with and you have to do that before you have an emergency so that even if your problem isn’t in your doctor’s field he can refer you to a competent specialist who also practices evidence based medicine. I am actually writing a book on this, or rather it will be one of the topics.

    I was disfigured by a very nice, caring MD 50 years ago who was terribly naive. He believed fraudulent drug ads in an era when drug companies were “regulated” in a way similar to the way that supplement companies are today, and yes, I have copies of the fraudulent ads and articles in med. journals warning doctors and pharmacists about them and many of those ads and articles are older than I am.

    That experience taught me a powerful lesson. If something is serious and I’m not incapacitated, I look at the evidence. I can tell very quickly whether or not an MD has also done.

    I have refused to return and told off many an MD. However, I’ve also been treated by many very competent caring doctors. One derm in particular who is very well known in his field but hates publicity never charged me because he said he learned from me. When I was half way across the country, he took my calls. We discussed an experimental treatment I wanted to try. He agreed but insisted that I let him check out the MD who would do it.

    When I learned that where I live now it takes at least 2 weeks for a new patient to get an appointment with an MD, I made an appointment with an internist who had treated my mother. I told him I didn’t have a problem and was only there so that if I did I’d be able to get in. We went over my medical records.

    Until I see marketing surveys showing otherwise, I will not believe that uncaring, incompetent MDs drive people to alt practitioners. I suspect that alt. patients consist of the “worried well”, people with psychosomatic illnesses, true believers with fringe beliefs and a few desperate people with terminal and chronic diseases that neither scientific nor “alt” medicine is able to treat. Talking to an apparently caring practitioner may make a stress headace go away, but it isn’t going to do anything for an ovarian cyst.

    As Dr. Hansen pointed out in the above article, scientific medicine is being watered down at least as far as the general public is concerned in that the lines are blurred by marketers who have gotten their products into what used to be scientific institutions. As one lady said to me several years ago, It used to be that when you went into a health food store you knew the products were dubious and when you went into a drugs store you knew that they were safe and reliable, but you don’t have that assurance anymore. The same is true of hospitals and “doctors” when the word “doctor” is now an umbrella term.

  25. weing says:

    Nyx,
    Sounds like those docs were CAM advocates.

  26. Nyx says:

    I currently live in… (get this)… Colorado! The same Colorado Dr. Hansen mentioned in his post. I did not know about the provision in the Colorado Medical Act concerning “alternative” medicine. It does explain a lot.

    In truth, I believe I was being treated as one of the “worried well.” The doctors I saw had come to the conclusion that my distress was psychosomatic and were treating me as such. But that begs the question as to why they would jump to such a conclusion. The evidence was there that my illness was physical, but they failed to find it.

    I realize that the plural of anecdote is not data. But personally I am amazed how many of my aquaintances and colleagues have gone to CAM (I really hate using that term, as I do not agree that it is medicine) practitioners. Overall their reasons were that doctors did not listen to them or give them the appropriate treatment, or any treatment at all in some cases. I have heard a number of stories that parallel my own. Are all of these people members of the “worried well?” I am not qualified to answer that question, but I sincerely doubt it. Mostly I have considered them educated and rational professionals in their various fields, up to the point they turned to CAM that is. Does turning to CAM prove the psychosomatic nature of their illness? Some of these people thought the experience was positive. Others did not see improvement, but they were still open to using an alternative therapy again. Mostly we commiserate while we wait for our situations to improve on their own, not knowing what else to do.

  27. I’m not expressing myself well. When I said that, “Until I see marketing surveys showing otherwise, I will not believe that uncaring, incompetent MDs drive people to alt practitioners. I suspect that alt. patients consist of the ‘worried well’, people with psychosomatic illnesses, true believers with fringe beliefs and a few desperate people with terminal and chronic diseases that neither scientific nor “alt” medicine is able to treat,” I meant people who intentionally seek out alt practitioners because they are alts. I think that alt or unscientific medicine has now been very well “integrated” into the health care marketplace with the result that a large % of mainstream consumers use it without knowing that it is not based on science but rather on belief systems or outright fraud.

    I think, but am not certain, that the surveys done to date show that unscientific medicine is far more popular with people with a college education than with those who have only gone to high school.

    Based on my own experience, I believe that people highly educated in the humanities, hard and applied sciences like physics and engineering who have no knowledge of medical science are the easiest to deceive because first it doesn’t usually occur to them that someone would claim that the statements they make are factual when they don’t have hard evidence to substaniate them or that people would believe and state their beliefs as facts without being able to demonstrate that they are. People in sciences other than medicine also often find it very difficult to deal with all the unknown variables that MDs and medical scientists have to deal with making it very easy for alts to deceive them. They accept false statements as facts and then are convinced by the logical conclusions many very inteligent alts draw from those statements.

    As an example, a man who sounded very rational and intelligent once told me how much chelation therapy helped him. He said that during WW II many shipyard workers had been poisoned by lead. After chelating them, doctors observed that they suffered far less from cardiovascular illnesses than others. I’ve never tried to verify that but would be amazed if it were true. It never occurred to him that the statement was false and the conclusion drawn sounded logical so he agreed to IV chelation “therapy”. When he felt good, he concluded that it was working and continued. Those trained in medical science would know that feeling food or being disease free after a treatment does not prove that the treatment is the reason. There are many unknown variables that could explain it and that is the reason that rigorous objective tests are required to determine benefits and risks.

    That brings us back to two things. First, we have got to start teaching some of the basics of medicine including its history to everyone, and second, we have to make sure that legally everyone who wants to “heal” humans or animals on a commercial scale or sell products which they claim do that is held to the same standards.

    While it is impossible to draw conclusions from stories on the Internet and I am not an MD or medical scientist, I would venture to guess that some of the problem Nyx experienced may have been caused by the cyst not appearing on the ultrasound and the fact that in this day and age when scientific medicine is held to such high sometimes irrational standards that fears of litigation may have something to do with practitioners either not observing or ignoring the visible symptoms she presented with. Again those who practice unscientific medicine should be held to the same standards. They shouldn’t be able to pull a treatment or supplement from a hat and sell it to a patient.

  28. Skip says:

    I was trying to find your website, but found this:

    http://www.peterhansonmd.com/about.html

  29. Nyx says:

    You do argue well, rjstan, and I appreciate your insights. I had an “aha” moment when I read in your last post: “I think that alt or unscientific medicine has now been very well “integrated” into the health care marketplace with the result that a large % of mainstream consumers use it without knowing that it is not based on science but rather on belief systems or outright fraud.” And therein lies the monster in the meadow. Dr. Hansen’s first statement “Passive acceptance of Alternative Medicine has eroded the quality of medical care in this country,” is so true precisely because passive acceptance leads to active acceptance. Educated or not, too few people look behind the curtain.

    I also appreciate your insight that with educated people “it doesn’t usually occur to them that someone would claim that the statements they make are factual when they don’t have hard evidence to substantiate them or that people would believe and state their beliefs as facts without being able to demonstrate that they are.” As I was born as skeptic and my first words as an infant probably were “prove it,” I find this kind of acceptance a bit alien. But with further reflection, I realize the truth in your statement. After all, who was it that I expected to tell me the truth and not deceive me: my doctor!

  30. My persective on unscientific or alt med. is incredibly unique. I am not a scientist, an MD or a Skeptic. In fact I drive a lot of them crazy and they me. I rarely go to a doctor and almost never take an OTC and never a supplement. The bulk of my medical encounters over the last 20 years have been with veterinarians. I love animals and usually have several dogs and cats at the same time.

    In 1995 I walked into a bookstore and saw two pet “magazines” on “natural pet care”. While leafing through one I saw a great big black title over an “article” that said “colloidal silver”. Colloidal silver is one of the drugs that causes argyria, gray skin, and at the time I was probably one of only about a few hundred people in the entire world who knew that because I had had argyria for about 40 years then. I was very excited, bought the publication and rushed home to read about people who look like me, but I didn’t find any. The piece never mentioned argyria or skin discoloration. The “article” made incredible claims about silver supplements which were followed by ads for the stuff, one even from the author of the “article”. It even said that researchers have found that people with a trace of silver in their bodies don’t get sick! Imagine my horror. I had breast cancer in 1984 and the nurses in pre-op were ready to resucitate me because they thought because of my gray face that I was in cardiac arrest! Could it be that in alt. speak breast CA doesn’t qualify as a disease? I think not.

    I was horrified. I thought that a terrible mistake had been made. I sent a very short letter to the editor explaining that contrary to what the article claimed the real reason silver fell out of use was that it causes argyria. When they refused to publish my letter, I knew that it wasn’t a mistake. It was fraud. The bastards wanted to make money and didn’t care who they hurt.

    I went ballistic. I investigated silver, dietary supplements and unscientific or alt med. and tried desperately to warn the public. I protested in the streets and at “alt” fairs. I contacted the media. I went to Washington and visited the FDA and Capital Hill, etc., etc.

    In the process I uncovered a huge amount of material that I’m trying hard to put into a readable form that will also hold the interest of the general public, the people who are the ones quacks target to market to. It is a very difficult task because of the volumn and type of the material and because I am such a terribly bad writer.

    The information I have is astounding to the general public. Many people who see it or read about me don’t want to accept money to help. That is from the local hospital on down where they refuse to take money from me when I copy articles in their library even though there is a big sign telling people that they have to pay to use the copier. The first fellow who posted material on my webpage and designed the layout didn’t want to charge me. He is a retired journalist and has 4 children, all 4 are chiroprators.

    A friend who is a retired drug chemist after looking at some of my material on the fraud, a friend whose father was an engineer and whose son is one was the first to point out to me how easy they would be to fool. He said that in their field fraud is hard to get away with since there are reference books every one checks. He said that while he was working he wouldn’t have paid enough attention to notice the lies being told to sell product, and of course like most others he is a decent human being who would never imagine that crooks would so blatantly lie to sell dangerous drugs or that they’d be able to get away with it legally.

    Until the general public learns that, unscientific medicine will take over a greater and greater % of the health care market place and more and more innocent people will be injured, killed and robbed and the injuries and deaths will not be accidents or unavoidable. They will be criminal.

  31. BlazingDragon says:

    Dr. Hall,

    My personality is to be relentless in my pursuit of a rational, scientific explanation, or barring that, I would experiment with FDA-approved treatments until I found something that gave some relief. I would make a terrible MD in today’s world, because my predilection would be to take the difficult cases, do the research, and try my damned best to help them, no matter how long it took and how hard I had to work. I’ve spent a month trying to synthesize a particularly difficult molecule that was needed for my work. I most certainly would not “give up” with a cursory glance as so many physicians seem prone to do these days. They don’t realize when they shrug their shoulders and give up like that, they are dooming the patient. A second or third opinion is often not useful because if you reveal you are there for a second opinion, most doctors will trust the first doctor’s diagnosis rather than the “hysterical, psychosomatic” patient in front of them.

    What makes my day job as a synthetic organic chemist particularly relevant to the practice of medicine is that I’ve had several molecules that look extremely simple on paper, yet all of the “easy, simple” approaches fail, often for baffling reasons. The solution (if there is one) turns out to be a combination of intuition, researching the literature to find a reaction that can be applied in a new, unique way to the current headache, trying completely new reactions based on first principles of chemistry, my and a lot of hard work (trying again and again until you succeed).

    I’m afraid modern, scientific-based medicine fails a LOT of the time when faced with the 1% symptoms. Doctors are taught to apply a set of general principles based on big, reproducible studies and people like Nyx and I fall through the cracks.

    The most ironic thing here is that toradol works great for my pain. I’d never had it prescribed for pain before and it was like a miracle after the lack of efficacy of most opiates I’ve had for moderate to severe pain in the past. I’d LOVE to take it instead of the iffy opiates. But I’ve had LPR since I was a teenager, and the sharp stomach pains I had after 2 weeks (of 24/7 dosing because the pain would wake me out of a fitful sleep at night) convinced me that I should stop taking it before I gave myself a bleeding ulcer. And the acidity I have is despite taking Prilosec OTC twice a day.

    Yet the surgeon declared that I don’t have pain worthy of vicodin any more. Vicodin works for this more moderate pain (don’t ask me why, but I’ve done trials with and without it). I’ve been on Aleve and tylenol, and it’s just not enough (and yes, I know aleve is also an NSAID, but what choice do I have?). My resistance to pain right now is at a very low ebb (not sleeping through the night for 3.5 weeks will do that). What I would really love is to not have the valleys where I don’t have good pain control (the not sleeping well for 8 hours is really getting to me). But the surgeon thinks I shouldn’t have pain, therefore I don’t. How evidence-based is that?

    rjstan, I don’t know if anyone has done the studies, but I think you are dead wrong about the callous way that people with an atypical presentation are treated by modern medicine. All it takes is one experience like I’ve had or Nyx has had and suddenly the promises of CAM will begin to look great, especially their hook about “modern medicine doesn’t have all the answers and they are trying to suppress our ‘wonder treatments.’” Most people don’t have the scientific background to distinguish just how full of crap these CAM lunatics are, so the promise of treatments that modern medicine is suppressing and work great are a siren song, helped out greatly by the fact that the placebo effect works just well enough to give these CAM quacks a veneer of legitimacy.

    I’m not here to ask for a treatment for my pain situation. I would like the MDs in the audience to see how easily people with atypical symptoms can fall through the cracks and how supremely hurtful the “it must be at least partly psychosomatic and/or hysterical” diagnosis is. Getting a diagnosis like that is like a gut punch to someone who is really suffering, and the casual way it is thrown around is really awful.

    Btw, my first inkling of worry with the current surgeon I’m dealing with is when he claimed my hyper-sensitive gag reflex was “psychogenic.” I should have damned well listened to the little voice in my head that yelling “danger, alert!” But I trusted him to know what he’s talking about (he’s been doing this for like 25 years) and look where it got me.

  32. Peter Hansen says:

    To all who replied so far: Thanks!!

    Replying specifically:

    weing- This is precisely why we are such a predicament. alt MDs water down the quality.

    BlazingDragon – There are MDs that don’t understand pain. Your search should continue. The scientific progress on pain is decades behind other problems. The research dollars are now going to prove acupuncture works as well as sham acupuncture. I, for one, think that money should have gone to research on chronic pain. Too many doctors of all types are using procedures and tools they know to try to help chronic pain, even when it doesn’t work. They succeed financially because they have a captive, desperate pool of patients. It is a very large pool too.

    Dr Harriet Hall – Thank you for your comments. It appears we are kindred spirits. Maybe our energies are in phase. (here’s where I need a sarcasm emoticon.)

    Nyx- doc 2, 3 and 4 have their own agendas. Its a good thing that you haven’t seen an OB/GYN in the south metro area, who believes most problems come from overgrowth of yeast! Diagnoses obtained quickly are usually not very accurate. The reasons for this are many, but the current consultative advice is “see more patients in less time.” Accuracy and quality do suffer.

    Your point about success is interesting. When a scientifically based physician fails, many people indict traditional medicine and its physicians. When alternative medicine fails, they are willing to give it another try. Please don’t be a victim of the “bad mexican food syndrome.” The syndrome is this: If you get a bad taco someplace, you refrain from going there again. It shouldn’t make you avoid all mexican food.

    Skip- yes, isn’t that interesting. It does make for some interesting conversations.

    rjstan@together.net – Thank you for sharing your story. I do have one criticism though: You are NOT a terribly bad writer!! Don’t sell yourself short. You have passion and a unique story that must be heard. You will get better and better at writing.

  33. BlazingDragon says:

    On a related note, I was reading this weekend and found out that the DEA has been cracking down on doctors writing “too many” prescriptions for narcotics. If my surgeon had told me “I’m afraid of getting in trouble” or “I’ve gotten in trouble before and I simply can’t prescribe you any more vicodin” or “here’s an alternative that is not an NSAID or a narcotic, please try this,” or a recommendation for a pain specialist, I wouldn’t be nearly as pissed off as I am right now. If he had done any of these legitimate options, I would be very disappointed, but being rational and compassionate, I would understand and deal with it. However, what this guy did is inexcusable, telling me I’m not in pain when I am. He didn’t offer up any reasonable, evidence-based solution, just insulted me and washed his hands of me.

    To make matters worse, I’ve had this happen with a surgeon before (my simple, early stage appendicitis was turned into an absolute fiasco by a surgeon who thought, just because I’m a chemist, I was scamming for narcotics. The appendectomy was perfectly routine and uncomplicated. Not catheterizing me on the operating table to empty my full bladder (I spent 6 hours in the ER on IV fluids before surgery) and the ensuing cramping and pulling on my fresh incision was an exquisite source of pain, made worse by the fact that the surgeon refused to treat it properly (this was in the days before the “patient’s pain bill of rights”). When I was finally catheterized that night (while fully awake), they removed over 2 LITERS of urine. Yes, that’s not a mis-print. I ended up spending 2.5 days in the hospital for a slightly inflamed appendix. I only got out when I was able to get another surgeon to take over the pain control, otherwise I would have been there another day or two longer at least, suffering all the while.

    Doctors who deny obvious symptoms with their patients or ascribe them to psychosomatic causes are a menace to modern medicine and are cruel and sadistic (whether they realize it or not). The “out” that pain medications are a problem because of the DEA or addiction issues could easily be handled by referring the patient to a pain specialist (or getting a pain consult for someone who is an inpatient). Yet I was not offered this option in either the past case or the present one (and I asked for a pain consult referral from my current surgeon at least 3 times).

    The MD crowd that write for this blog and comment on it, from what I can tell, would not do something like that to a patient. It’s too bad their brand of medicine is all too rare in the larger world.

  34. BlazingDragon says:

    Dr. Hansen,

    I am fully aware that pain management is behind the curve, research wise. Your point about acupuncture for pain is also quite valid. But neither of those address my point that non-scientific, belief-based methodologies are the norm for treating pain. If a doctor believes this is how pain is treated, that is how they treat pain, and there is a high level of belief in stuff that simply doesn’t work in pain treatment. This is, to a lesser degree, a problem in many disciplines of medicine, where there are few (or no) lab tests that give relatively unambiguous answers.

    It is a matter of attitude among the doctors. Most doctors believe they are “above” the lay people, that their patients will never teach them anything worth knowing, and the belief system they come out of medical school with (a product of their particular inclinations/prior beliefs and their teaching) tend to stay “stuck” for a very long time in their practice. With a heavy biology background and a day job as a synthetic organic chemist, I could teach (and have attempted to in the past) doctors a lot about the deceptive marketing of pharma companies (the re-patenting of the L or D optical isomer of a drug vs. the older racemate is a particular pet peeve of mine). Yet no doctor so far has been interested in learning a damned thing. The pharma rep who gives them food (and has a massive conflict of interest) is far more legitimate than a guy who works with this stuff every day.

    Until attitudes among doctors change, the “bad taco, hate mexican food”analogy will hold. When one gets kicked in the gut (like being told your real, physical symptom is all in your head) is a powerful motivator to seek out (and then get captured by) alt-med providers. People HATE being told they are nuts when they aren’t (and even when they are). The fact that the alt-med providers have the placebo effect to give them a veneer of “it works” means doctors will have to work a LOT harder than the alt-med providers and one slip-up for an MD can drive a patient away from MDs in general. That isn’t a threat, it is a statement of human nature and the risk-averse way most people deal with life.

    I have kept going back to MDs because, being well-versed in many branches of science, I know how full of crap the alt-med providers are. But even I get tired of being looked down upon. ridiculed, and wasting my time, energy, and money for repeated snubs. When the case is an acute one like mine, letting the “system” work just means I’m gonna be dealing with pain. It has the side benefit of “going away by ignoring it long enough” too. The fact that I suffer in the meantime seems to be utterly meaningless to most of the doctors I’ve met in my time.

  35. Harriet Hall says:

    “It’s too bad their brand of medicine is all too rare in the larger world.”

    I don’t think it’s rare at all. I think it’s the norm. You’ve had bad luck. The bad stories get our attention and are remembered and repeated. The common everyday good stories trundle along below the radar.

  36. apteryx says:

    BlazingDragon wrote: “The fact that the alt-med providers have the placebo effect to give them a veneer of “it works” means doctors will have to work a LOT harder than the alt-med providers and one slip-up for an MD can drive a patient away from MDs in general. ”

    The same should apply to MDs. Some people write as if response to conventional medicine is 100% [non-placebo] bioactivity and 0% placebo effect. In fact, all treatments (outside prophylactic “treatments”) have some degree of placebo activity. If a naturopath and an MD give you a bottle of similar-appearing pills for your angina, you should have similar levels of placebo response to both pills. Should the MD’s prescription produce better results, it will be because that drug has better bioactivity on top of similar placebo effect. Even when the MD’s treatment is biologically no better, it should have an equal “veneer of ‘it works’” – unless, perhaps, the manner and enthusiasm with which he recommends it are different. Asking the MD to respect patients’ dignity, smile once in a while, and speak with reasonable optimism does not constitute making him work far harder than a CAM provider.

  37. Blazing I’m terribly sorry that you are in such horrible pain. But I would like to point something out. Regarding what I wrote, you said, “I think you are dead wrong about the callous way that people with an atypical presentation are treated by modern medicine. All it takes is one experience like I’ve had or Nyx has had and suddenly the promises of CAM will begin to look great…”

    First, I have tried to address several general issues but those did not include your problem or the problem that people with an “atypical presentation” have with MDs. The stories Nyx told sounded to me like stories about incompetent MDs. According to her, she had pain and swelling caused by an ovarian cyst. The cyst was missed by 4 MDs and picked up in the ER. I’m not a doctor but I assume that ovanian cysts are rather common and that if anyone of the 4 OB-GYNs she saw had been competent that he would have discovered it. I also assume that an alt. practitioner could not relieve the pain of a person with an ovarian cyst but that he could relieve the pain of many suffering from psychosomatic illnesses so that if someone with an ovarian cyst went to an alt she would still wind up in the ER as displeased with the alt as she was with the incompetent MDs.

    I know nothing about the medical problems you are talking about. You are an anonymous person on the Internet. I have no way of knowing if you are correct or if your doctors are. I have met enough incompetent MDs to realize that you may be right, but I have also met enough people who do have psychosomatic illnesses to realize that the doctors may be correct. In other words, I simply don’t believe that I am in a position to draw any conclusion other than that you appear to be in great pain and that you aren’t getting the help you need.

    But I also understand how very difficult it is for most clinicians to experiment on patients even with approved drugs and accepted therapies. It isn’t the same as experimenting in test tubes in a chemistry lab. I think it is important for everyone, but most especially for someone with a history of atypical presentations to find a primary care physician he is comfortable with when he is well so that the physician can direct his care in emergencies and yes, I know that that can be easier said than done.

  38. BlazingDragon says:

    Dr. Hall,

    Maybe medicine is different where you practice. It might be a thing of the area I live in (San Diego). But my wife and I have had a LOT of contact with doctors over the years, and it has been bad about 70% of the time. Our sample size runs to a few dozen doctors too, between the two of us. This is not a bias against remembering the bad and forgetting the good. I can count on one hand (easily) the number of good doctors/surgeons I’ve had in the last 10 years and I’m damned grateful for every single one of them (the surgeon who gave me percocet for my osgood-schlatter’s bone spur removal cheerfully, without any reservations, then vicodin was a godsend). But he is all too damned rare (this surgeon, incidentally, was the one who did one of my wife’s hip replacements and did a damned good job of it too, unlike her other hip replacement (she was only about 32 when the 2nd hip was replaced)). Another good doctor was also my wife’s doctoral adviser (Ph.D. in immunology, working for a rheumatologist), who stepped in after the staff rheumatologist screwed up her lupus nephritis treatment and let her anti-DS-DNA titer begin to rise after suppressing it with cytoxan.

    As much as you might not want to believe it’s not the norm, I doubt your colleagues tell you when they routinely write off stuff as “psychosomatic” or “psychogenic.” It’s just too deeply ingrained in the system (again, with the caveat that this may have mostly to do with the doctors in the San Diego area).

    Most doctors (especially GP/family practice) are paid for crap, put up with huge case loads, and have insurance companies who don’t put any value on good old fashioned detective work (the kind needed to diagnose rare symptoms/reactions).

    My wife works in rheumatology research (RA) and has colleagues who work with lupus. Lupus research has been stymied for YEARS by a few physician-researchers who jealously guard their turf and don’t want any new ideas because they didn’t come up with them, but they are too ossified and lazy to come up with those ideas on their own, so all of lupus research in the USA has suffered (it is finally starting to change). These people have been destroying anyone who rises to challenge their comfy spots at the top of the heap and to hell with the patients.

    One can either continue to believe they are aberrations or doctors can stand up and begin to police themselves. Doctors policing themselves will require a lot of hard questions, uncomfortable answers, and a lot of pride-swallowing. Yet contact with callous doctors who have little or no intellectual curiosity will continue to feed the meme (promoted by the billions of ill-gotten gains) touted by alt-med providers that “trad-med” just doesn’t care about patients and doesn’t have the answers (which they conveniently do, for $99.95 and up). The fact that modern society is so scientifically ignorant and the laws of the country have been perverted to help these fact-free monsters makes the fight that real doctors have all the more difficult.

    The suffering of the patients is very real, and a decent minority of people will have at least one incident in their life (or one of their friends/family will) that doesn’t fit “normal symptoms” and will get chewed up and spit out by harassed and/or lazy doctors, making more potential marks for alt-med practitioners.

  39. durvit says:

    It is hard to believe that this is true but the NYT is carrying an article about a couple who is marketing a placebo pill for children: Experts Question Using Placebo Pills to Treat Children. Is this going to carry an appropriately-worded script in the box?

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