The Spirit of St. Louis Renault

Summer time is finally here in Oregon, and I will confess that I have spent little time on blogging.  The sun is out, my kids are out of school and home from college, and really, who wants to spend their time writing when you could be on the golf course or at the beach with the kids.  I say this as a mea culpa for what follows.

One of the saving graces in medicine is just how hard it is to harm people and how much trauma humans can withstand and survive. When I am on call for my partner I cover a Level 1 trauma ICU and the hallway leading to the unit is lined with photographs of some the trauma survivors. Over the years I have helped take care of many of these patients and I remember the extent of the injuries and the intensity of the care required to pull them through. Most of the survivors are young; it is the young who have the physiologic reserve to deal with the stress of injuries and their consequences.

Still, human physiology is amazingly resilient, especially of there are no co-morbid conditions to interfere with healing. With a little, and sometimes a lot, of support, I am constantly amazed at what people can sometimes survive.  Modern medicine can pull people through who would have certainlu died 20 years ago.

There are two way to hurt people: what you do and what you do not do, the harms of commission and omission. Harm can be obvious with surgery. Oops, sorry I left my watch in there.  I definitely do not have what it takes to be a surgeon. Or you can prescribe a medicine with a known side effect. Most SCAM’s, by doing nothing, are not prone to this sort of harm. Chiropractic and acupuncture are the notable exceptions, but even then it is hard to tear a vertebral artery or drop a lung unless the patient is extraordinarily unlucky. Of course one of the things you learn in medicine is that occasionally someone is extraordinarily unlucky and has a rare, but not unexpected, complication of an intervention, SCAM or otherwise.

When people ask what is the harm of a given SCAM, I am often left with pointing to very rare events from sins of SCAM commission or talking about the financial and emotion costs of therapies that can’t work and don’t work, which are hard to measure.  I suspect sins of SCAM omission are equally uncommon, since few people rely on SCAM’s alone for their health care. Most people ‘integrate’ their nonsense with standard health care, so going without real medicine is unusual.  I suspect.

I still see the occasional case where the patient, for financial reasons, decides to go without any health care and presents with a preventable but  fatal stroke, or heart attack, or end stage AIDS. If they had lived in a society with a reasonable health care system, they would not have died young from the Hobson’s choice of health insurance.

Relying solely on SCAM therapies as a substitute for standard medical therapy is not a wise course of action. Real medicine can be dangerous and uncomfortable, but it is effective. Relying on magic reliably leads to progression of illness and death. My second favorite computer (after the Mac) routinely discusses the consequences of relying of SCAM treatments for cancer. They die. Of cancer.

There are other high profile cases who die from either denying their disease or opting for alternative therapy. More often than not, like most, people die from alternative medicine quietly and unknown outside their local friends and family. It would be difficult to document how harm occurs from sins of SCAM omission; it is hard to hear the dog that didn’t bark.

A recent example of the sins of omission and commission occurred in Canada. There is a company in Canada, Truehope, that sells supplements for the ‘treatment’ of metal health diseases: depression, bipolar disease, and anxiety. Health Canada has warned against the product and has unsuccessfully tried to prevent its sale.

Jordan Ramsay is a schizophrenic who stopped his medications and substituted Truehope products by his parents.  It did not go well as suffered a worsening of his disease then beat his father to death and severely injured his mother.  The judge laid blame on Truehope:

In her ruling, Judge Deborah Kloegman blamed the Ramsay family’s decision to replace Jordan’s psychiatric drugs with what purport to be mentally therapeutic multivitamins, for contributing to the fatal attack.

“The accused was not taking his sorely needed medication at the time of the offenses, or at least not in the recommended dosage,” Kloegman ruled, referring to testimony from Ramsay’s psychiatrist, Dr. LeeAnne Meldrum. “His parents had unilaterally decided to reduce the dosage a couple of weeks before the night in question and then replaced the medication with power vitamins.

It is sad, but not unusual, for reliance on alternative therapies to result in poor outcomes. The website is a depressing litany of the consequences of preferring fantasy to reality.

Here is the point where some commentator will mention the number of deaths from medicine, as if somehow that justifies the use of magic. As an update, with the aggressive use of science and applying it to patient care, since April 2008 Legacy Health, where I work, has reduced combined infections (SSIs, VAPs, CLA-BSIs, CA-UTIs) by 56.5%.
This equates to more than:
• 360 prevented deaths
• 1600 prevented infections
• $12 million annually in avoided costs from the prevented infections

Not a bad application of science and evidence. I ask again. Does anyone know of any quality initiatives in the world of alternative medicine that have led to a decrease in morbidity and mortality? I think not.  SCAMs do not work that way:

I love having a medical philosophy (naturopathy) that is clear and consistent and that does not shift. I love being able to look at new approaches that may come along and to ask myself, “Is this within the bounds of the philosophy I so embrace?” And if not, to let it go. It is easy to be loyal and dedicated to an elegant philosophy…

No sense in letting reality intrude on your ND/alternative philosophy.  Trofim Lysenko would have been an alternative medical provider if alive today.

The column where I learned about the Truehope case was a litany on the failures of regulation and health care systems to stop the sale of products that harm people or are a worthless substitute for effective medical care. The author, Marvin Ross, is understandably irate and angry that this occurred an demands an explanation

Health Canada told the Province that “it licences the company to use several nutritional supplements but does not allow them to claim them as a cure for schizophrenia or bipolar disorder.” Well, Health Canada has been well aware of their making those claims since at least 2000 and making those claims is illegal. Where have they been?

LeeAnn Ramsay and her family and all Canadians deserve the investigation that she is demanding. Why the tragedy that befell her family was allowed to happen needs to be explained and the cause rectified. I agree with her and hope she gets it.

I hate to admit it, but I laughed when I first saw the article, although I laughed before I read the content. One of my favorite scenes in the movies is in Casablanca, where Louie closes Ricks place:

[Renault has ordered that Rick’s close immediately]
Rick: How can you close me up? On what grounds?
Renault: I’m shocked, shocked to find that gambling is going on in here.
Employee of Rick’s: [hands Renault money] Your winnings, sir.
Renault: Oh, thank you, very much. Everybody out at once!

It is the second best example of bald faced hypocrisy and greed ever. The best? Probably the source of the editorial,  the Huffington Post or as my second favorite computer likes to call it, that wretched hive of scum and quackery.

Really? The Huffington Post has their knickers in a twist over a bad outcome from alternative medicine?  The same Huffington post that, I suppose without any irony, ran a piece saying:

I believe” is not good policy…Where else might we apply the “I don’t believe” analysis? How about: I don’t believe I’ll be in a car wreck so I won’t wear my seat belt and I’ll turn off the air bags. Really? No way. I’d be ticketed for not wearing a seat belt. Why? Because “I don’t believe” doesn’t prevent accidents. It’s why we want every man, woman and child in this country to have access to affordable health care, because “I don’t believe I’ll get sick” doesn’t mean diddly.

Except alternative medicine. If you search the website you get mostly favorable/credulous returns covering the gamut of the medically ridiculous. 1760 hits for homeopathy, 137 for naturopathy, 3520 for acupuncture, 14,700 linking vaccines and autism, 121 on energy medicine, 29 on applied kinesiology etc. etc.  That does include comments in the search.

There has been multiple entries on this blog about the medical content of the Huffington Post. Reality based medicine is not their strong point.

Nonsense will thrive where it receives nourishment, and the Huffington Post is an all you can eat buffet.  Captain Louis Renault is a better metaphor than I originally suspected.  It is curious when a web site that promotes the kind of nonsense that leads to bad outcomes is  the same website then decries the same nonsense.  “I’m shocked, shocked to find that alternative medicine is going on in here.”  I doubt that one one reality based entry is likely to be the beginning of a beautiful friendship.

* you will have to pry my MacBook Pro from my cold, dead hands

Posted in: Science and Medicine

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