I know a woman who is a survivor of colorectal cancer. At one point, doctors had given up hope and put her in hospice, but she failed to die as predicted and was eventually discharged. She continues to suffer intractable symptoms of pain with alternating diarrhea and constipation. I don’t have access to her medical records, but she tells me her doctors have talked about irritable bowel syndrome (IBS) and have also suggested that the heavy doses of radiation used to treat her cancer may have caused permanent damage to her colon. Whatever the cause, her symptoms have seriously interfered with her mobility and her quality of life. Her health care providers have recently recommended questionable treatments in what I think can be construed as using CAM as a dumping ground for difficult patients.
Colonoscopy hadn’t shown any obstruction, but one of her doctors had hypothesized that her symptoms might be due to impaired bowel motility in the irradiated area. She was desperate enough to consider surgery if there was a chance that bowel resection or colostomy might improve her symptoms. She belongs to a large, well-known HMO with a good reputation. She asked her primary HMO physician who thought the idea was plausible and referred her to a surgeon. The first surgeon said surgery was not indicated and referred her to another surgeon on staff. In addition to being board certified in general surgery, the second surgeon was allegedly board certified in something related to CAM (my friend can’t remember his exact words and has been unable to verify any such credentials online).
The surgeon recommended acupuncture, not once but twice. My friend’s husband (who teaches statistics at a nearby community college) told the surgeon that he was fascinated by the challenges of double-blinded studies of acupuncture and that he was aware of no benefits beyond the placebo level. The surgeon then retreated a little and suggested that the primary benefit of acupuncture in treating IBS was the “relaxation” effect.
From an e-mail I received:
As a proponent of SBM, and a someone who places a high value on reason, logic and evidence, I would like to find a physician who shares this mindset.
He went on to ask how he could go about finding one.
Another correspondent was referred to a surgeon by her primary physician, and the surgeon inspired confidence until she started talking about using homeopathic arnica pills to improve healing post-op. How she could determine the technical competence of this surgeon? Was acceptance of homeopathy a reason to shed doubt on her judgment in other areas? Should she seek a second opinion?
I get a lot of inquiries about how to find a good doctor. I don’t have a good answer. I thought it might be useful to throw out some ideas that have occurred to me and hope that readers will have better ideas and will share their experiences about what has or hasn’t worked. (more…)
I’ve already devoted more time to Protandim than it deserves. I’ve written about it twice on SBM: here and here . But I can’t resist covering a new Protandim study that not only serves as a bad example but that made me laugh.
Protandim is a mixture of 5 herbal supplements intended to upregulate the body’s own production of antioxidants. Its patent application claimed that it was useful to treat or prevent an astounding 126 diseases and medical conditions, from tinnitus to aging, from hemorrhoids to cancer. At the time of my last article, only one human study had been done. It found increases in blood test markers and interpreted them as a surrogate for increased antioxidant activity in the body, but did not even attempt to assess whether those increases corresponded to any measurable clinical benefit, for cancer or for anything else. I begged Protandim supporters not to ask me about it again until there were human clinical studies with meaningful outcomes.
Now there is finally a second human study, although still not one that qualifies as a clinical trial. Curiously, it is not listed on the company’s website. I wonder why? Perhaps because it showed Protandim didn’t work. Oops.
Two weeks ago I wrote about the demise of the traditional annual physical for healthy adults who have no symptoms.
The First Step: Identifying a Symptom
People who do have symptoms should see a doctor. They should have appropriate evaluations that may or may not include a partial or complete physical exam. One problem is that people may not be able to decide what qualifies as a significant symptom. Could the heartburn actually be a heart attack? Is the fatigue a normal result of exertion, or could it be a sign of something serious? Could my headache be a sign of brain tumor, or should I just take an aspirin? My spouse says I’ve been snoring more: could that be a sign of sleep apnea? What if I just “don’t feel right”?
This is a real dilemma, because minor transient symptoms are a normal part of life. Some of them are due to trivial conditions that spontaneously resolve; some are sensations due to the normal functioning of the body. Some people are more aware of these sensations than others. Paying attention to them tends to make them worse. Some people barely let these minor sensations intrude on conscious thought; others fixate on them and obsess about them. There is a spectrum of human reactions ranging from the stoic denier to the hypochondriac. (more…)
An article (and associated news video clip) from ClickOn in Detroit is titled “Alternative treatment helps Michigan doctor beat infertility.” This is a misleading title, and the report is an example of poor science reporting.
Was She Infertile?
The patient in question was a 33-year-old family practice doctor who believed she was infertile. By definition, infertility is failure to conceive after a year of regular intercourse without contraception. She didn’t meet that definition. She only tried for 6 months before seeing a doctor, and then for 2 more months (with some kind of unspecified medicine) and then she consulted a reproductive endocrinologist who apparently told her she was infertile because of a high FSH level. Then she “did her own research” and supposedly found that acupuncture was a key part of infertility treatment. So she sought infertility treatment from an acupuncturist.
Please note: the following refers to routine physicals and screening tests in healthy, asymptomatic adults. It does not apply to people who have been diagnosed with diseases, who have any kind of symptoms or signs, or who are at particularly high risk of certain specific diseases.
Throughout most of human history, people have consulted doctors (or shamans or other supposed providers of medical care) only when they were sick. Not too long ago, the “if it ain’t broke don’t fix it” mindset changed. It became customary for everyone to have a yearly checkup with a doctor even if they were feeling perfectly well. The doctor would look in your eyes, ears and mouth, listen to your heart and lungs with a stethoscope and poke and prod other parts of your anatomy. He would do several routine tests, perhaps a blood count, urinalysis, EKG, chest-x-ray and TB tine test. There was even an “executive physical” based on the concept that more is better if you can afford it. Perhaps the need for maintenance of cars had an influence: the annual physical was analogous to the 30,000 mile checkup on your vehicle. The assumption was that this process would find and fix any problems and insure that any disease process would be detected at an early stage where earlier treatment would improve final outcomes. It would keep your body running like a well-tuned engine and possibly save your life.
We have gradually come to realize that the routine physical did little or nothing to improve health outcomes and was largely a waste of time and money. Today the emphasis is on identifying factors that can be altered to improve outcomes. We are even seeing articles in the popular press telling the public that no medical group advises annual checkups for healthy adults. If patients see their doctor only when they have symptoms, the doctor can take advantage of those visits to update vaccinations and any indicated screening tests.
Remember the movie “Attack of the Killer Tomatoes”? That was fiction, but some alarmists would have us believe that the tomatoes and potatoes on our plates are really out to get us.
I recently got an e-mail inquiry from an MD who said he had read that solanine in tomatoes, potatoes, and eggplants could be responsible for essential hypertension and a number of GI complaints, as well as symptoms of rheumatoid arthritis, apparently through their inhibition of acetylcholinesterase. He had looked for supporting scientific studies and hadn’t found any. He wondered if I had seen any such studies. I looked too. I couldn’t find any either.
Applied kinesiology (AK) was briefly mentioned in Scott Gavura’s article on Food Intolerance Tests last week. Since AK is arguably the second silliest thing in CAM after homeopathy, I thought it wouldn’t hurt to say a little more about it.
A press release on the Wall Street Journal website recently announced that a chiropractor in Illinois was offering “Nutrition Response Testing”
…to help patients optimize overall health…[the test] determines the specific balance of nutrients necessary to optimize metabolic function at the cellular level… the chiropractor then uses this information to make nutritional recommendations for patients…[the test] provides precise feedback that can also help identify the underlying cause for chronic pain and illness.
Note: The James Randi Educational Foundation (JREF) is publishing a new series of e-books. The first two offerings are an excellent new book on critical thinking by Bob Carroll, Unnatural Acts, and the first in a planned series of republications of classic skeptical works, Homeopathy and Its Kindred Delusions, by Oliver Wendell Holmes. I was asked to write the introduction for the latter, and the JREF has kindly given their permission for me to reproduce it here.
The German philosopher Hegel said, “We learn from history that we don’t learn from history.” “Homeopathy and Its Kindred Delusions” is a remarkable little book based on two lectures Oliver Wendell Holmes gave in 1842. It is a masterful debunking of homeopathy. If his lessons had been taken to heart, homeopathy would not have survived and we could have avoided a great number of other medical delusions that continue to plague us today, both from charlatans and from well-meaning advocates who lack Holmes’ critical thinking skills.
To realize just how remarkable this book is, imagine the world of 1842. Samuel Hahnemann, the inventor of homeopathy, was still alive. Roentgen wouldn’t discover x-rays until 1895. The germ theory was not yet established. Semmelweis wouldn’t make his observations on puerperal fever until 3 years later. It wasn’t until 1854 that John Snow removed the Broad Street pump handle and stopped a cholera epidemic. Koch’s postulates for determining infectious causes of disease weren’t published until 1890. Doctors didn’t wash their hands or use sterile precautions for surgery. Bloodletting to “balance the humors“ was still a common practice. The randomized placebo-controlled trial wouldn’t appear for another century. Contemporary medicine often did more harm than good. In fact, Holmes himself famously quipped “I firmly believe that if the whole materia medica could be sunk to the bottom of the sea, it would be all the better for mankind and all the worse for the fishes.” (more…)
In writing about science-based medicine, we give a lot of attention to medicine that is not based on good science. We use bad examples to show why science is important and how it is frequently misapplied, misinterpreted, misreported, or even wholly rejected. It’s a pleasure, for a change, to write about a straightforward example of the best of science-based medicine in action. The book Heart 411 is such an example.
The medical literature is a jungle of conflicting and complicated studies. It’s difficult for novices and even for sophisticated non-specialists to navigate. It’s useful to have experts as guides who can apply their knowledge, experience, and judgment to analyze the data and put everything into perspective. I can’t imagine anyone more qualified as guides to “matters of the heart” than the authors of this book. Heart surgeon Marc Gillinov and cardiologist Steven Nissen practice at the Cleveland Clinic, which has been ranked as the number one heart hospital by U.S. News & World Report for the last 15 years and is currently ranked 4th best hospital overall. They have treated more than 10,000 heart patients over 30 years of clinical practice and have also done extensive research and published hundreds of articles in peer reviewed journals. Their book contains everything they would like their patients to know about the prevention, diagnosis, and treatment of heart disease. It amounts to an owner’s manual for the heart. (more…)