maybe in an alternative universe…


I read recently that about 70% of New Zealanders use ‘alternative’ medicines (NZ Medical Journal, 2007) – more than in many countries, and very common among the people I see who have longterm pain. (As an aside, have you ever wondered at the irony of someone who refuses to put nasty chemicals into their body, prefer ‘natural’ medicine, but smoke both tobacco and marijuana?!)

Among the ‘alternative’ options, one woman I’m seeing at the moment is wearing copper bracelets, several hematite pieces of jewellery, drinks no carbonated drinks ‘because it excites the nerves’, has regular healing touch massage with aromatherapy, and ingests a variety of homeopathic concoctions. She was horrified to hear that the magnetic underlay she bought has no known effectiveness, but was still considering whether she should ask a health agency if they would buy her a massage chair…

The amount of money that is spent by people desperate to find something to fix their pain is incredible!

Which leads me to a book I’m thoroughly enjoying at the moment. It’s called ‘Trick or Treatment’ and is written by Professor Edzard Ernest, Professor of complementary medicine and Dr Simon Singh, science writer, and is published by Bantam Press.

It’s a very readable book, and the chapter I’m loving the most is actually the first – a wander through the history of the double blind, placebo-controlled, randomised clinical trial – and includes blood-letting, Florence Nightingale, scurvy and early research into smoking! The authors argue that the most significant contribution to modern medicine is evidence-based medicine (although some of my colleagues still argue that it’s all very well, but there just isn’t enough evidence yet…). One quote from Hippocrates stays in my mind “There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance.” Oh if only more basic scientific principles were taught in schools, we would have so much less opinionated nonsense!!

Other chapters cover the evidence for acupuncture, homoeopathy, chiropractic, herbal medicine – and the final chapter ‘Does the truth matter?’. I haven’t got there yet (I’m still half-way through acupuncture!), but a quick flick right to the end Appendix ‘Rapid Guide to Alternative Therapies’ shows a long list of locally popular remedies including colonic irrigation (why would you?!), magnet therapy, orthomolecular therapy (wha..????), Reiki – well you’ve probably got the idea now!!

Recommended reading for all of us who work with patients who are likely to have thought about or tried at least some of these approaches, this book is well-written, somewhat simplistic but having said that, is attempting to summarise hundreds of studies into lay language. Enjoy.

8 comments

  1. There is a lot to be said for faith and hope and the power it has on health. Stories of people ‘healing themselves’ or miracles are aplenty and largely thrown out by the medical community. Little is shown though at a persons wellbeing with some of these cases. Fine, they may not have been ‘healed’ by a wacky treatment – but how did they feel? Undoubtedly the next large medical advances will be understanding the interplay between the mind and physical body and Im sure we will look back on some of these and say ‘ahh so thats why the people took them up! its for the social element..[or].. the feelings of empowerment’.

    We all have our own methods of finding it and in many respects there is absolutely nothing wrong with whatever method that you find. Just look at the numbers of people who turn to God at difficult time in their life – just to try and answer their questions. Similarly, why is it humans are so desperate for a diagnosis? I think what’s dangerous is when people tout these alternative remedies as something more and give OTHER people false hope.

    Some trials of OT have been shown to be not that effective in clinical practice. However undoutbedly those that do ‘seem’ to do well are those people who appreciated the talking side of the therapy. The cognitive elements to talk through their problems and issues. Its these elements that exist in what some called ‘holistic’ therapies. Interesting that they call it ‘holistic’ – something that OT’s have been touting about as a central aim to their practice for years.

  2. Thanks for your comment Will – and it’s lovely to see you visit!
    The reasons I’m not comfortable with ‘feeling better’ or relieving distress alone include that people may misattribute this temporary relief with longerlasting relief, that it is temporary, that it often relies upon something external to the person (and therefore not able to be carried with the person on a long term basis), and that it is very reinforcing so can rapidly become a psychological dependence. If the person has to pay, then it’s expensive.
    There is some research suggesting that spending time with someone who will listen is as helpful as spending time with someone trained in listening skills – but again this provides temporary relief of distress rather than longterm change to reduce the risk of distress occurring again…

    I’m not sure occupational therapists can actually, with hand on heart, say that they are holistic in their practice – at least in an acute setting, it’s entirely possible that occupational therapy is bastardised, and consists only of issuing equpiment!

    I’m also not convinced that occupational therapy per se is able to demonstrate an effect that can’t be explained by what Dan Moerman calls ‘meaning response’.

    My desire is to examine how these effects work, and how to reproduce them so that the people I work with will learn to do it for themselves rather than become reliant on someone or something else.

  3. I believe you have a myopic, prejudiced mind and perhaps are the inhabitant of an alternative universe yourself .
    Scientific studies in pharmaceuticals has been proven time after time to be inadequate;fudged, erroneous,fabricated lies and rushed to market for purposes of profit by the abusive “priests of medicine “.Medical journals refuse to publish orthomolecular studies and then claim there is no scientific “proof”.Science is ultimately theories and opinions that undergo complete reversals from time to time.
    Drink from your own well if you must put please refrain from poisoning mine,they serve me well.
    .You appear to be infatuated with your own opinion and dismissive of the abilities of others to form and act on their own investigations and knowledge garnered from sources others than yourself.

  4. Thanks for taking the time to comment – and I am sure you’ve already made your mind up that I will firmly disagree with you.

    I’m not sure if you’ve read through my posts, but I don’t post about pharmaceuticals.

    Science is about theory generation, hypothesis development, and systematically testing, so that knowledge builds upon knowledge – and yes, paradigms do change substantially over time.
    I’m grateful to the people who have gone before me and continue to put theories to test, to collecting data, to continually revisiting and revising theories about how things work. This is how and why knowledge accumulates. Science isn’t about opinions – unless you’re referring to the fact that it’s an opinion to hold the belief that by systematically testing each tenet of a theory we can develop knowledge that stands the test of time.

    I hope that anyone who reads my posts takes the time to reflect on what I put forward and comes to his or her own conclusion. I know I’ve said before and will say again, test everything yourself, don’t assume anything, check it out yourself. I encourage you to do so too, about anything you read on the internet.

    If I’m prejudiced, I hope it’s prejudice towards allowing people to judge treatments according to the same standards, whether they are ‘alternative’ or ‘usual practice’. I also hope it’s prejudice to use science rather than dogmatism or vociferous argument, so that I can turn to repeated studies across different populations in different countries that arrive at the same conclusions.
    Thanks for commenting, and I hope you visit again.

  5. “As an aside, have you ever wondered at the irony of someone who refuses to put nasty chemicals into their body, prefer ‘natural’ medicine, but smoke both tobacco and marijuana?!”

    No,I haven’t wondered how addiction can get a hold on a person and make them do things that are not consistent with their health goals. You seem either above relating to patients with problems like addictions or just naïve about them.

    I do wonder what type of professional talks about his patients – questioning their beliefs (copper bracelet, jewelry, carbonated beverages) and how that is a demonstration of professionalism. Gossiping about your patients is petty. Are these the types of comments you make to your patients (telling one patient about another); then why make them here? Your comments seem disrespectful to me.

    A health care professional who shows a lack of respect for his patients concerns seems uncaring. So what if she wants some health agency to buy her a massage chair. It sounds like you “judge” her unworthy of this. What is the point of mentioning her wanting the massage chair?

    Blogging about your patients in this way makes you look like a disenchanted health care worker. If you are not happy in your job you might consider something “more scientific” and less patient centric.

    Don’t judge a book by its cover. Don’t assume an opinion on something you don’t know anything about. You haven’t finished reading the book but you can’t stop from blogging about.

    “…colonic irrigation (why would you?!), magnet therapy, orthomolecular therapy (wha..????), Reiki…”. It sounds like you haven’t read about these therapies in the book but seem to be expressing an opinion or an attitude about them – “why would you?!”

    I don’t understand those who claim that science and objectivity is so important but blog about personal details about their patients efforts to deal with chronic pain. There is a time and place for everything. Science or compentency alone will not make a great healer. Compassion can not be taught but must be felt or experienced.

  6. Thank you for taking the time to comment on this post.

    I’m very happy in my work – although like most people, I find it helpful to question all that I do in an effort to learn.

    I do question why people (including myself and possibly you) do things that aren’t consistent with their health goals. While smoking tobacco is an addiction, it’s not an addiction to choose to decline scientifically validated management approaches while at the same time choosing to use unscientifically validated interventions, on the basis that it’s ‘more healthy’. That isn’t a logical argument.

    With respect to any intervention provided through public health funding, why would you not want to know that the intervention works and for whom? When a massage chair can be demonstrated to promote independence rather than temporary distress reduction, then I may be able to support it. Where ‘should’ the public health funding be spent? On something that’s based on opinion (or a sales pitch), or on something that has had some research support?

    As for not having read the book – I have. I have also read much on alternative therapies – from a wide range of sources. When and if these alternative therapies are subjected to the same rigour as ‘conventional’ therapies, and when and if they can demonstrate adequate repeatable results, then I’ll revise my opinion. In the meantime it’s not responsible to argue for their use.

    You suggest that I don’t care for my patients. This is a shame – respecting someone doesn’t mean I need to agree with them, nor leave their beliefs unchallenged when there is evidence to the contrary.

    I do find it sad when people I work with spend their time, money and hope on ‘alternative’ interventions that simply don’t have evidence to support their use. Even these patients report that their experience is of limited and temporary, if any, effect. And, sadly, with chronic pain, even evidence-based approaches don’t always provide lasting results.

    There’s no doubt that experiencing a chronic health problem is incredibly difficult. All I can offer people is what the evidence suggests has an effect, and what offers people self reliance so they don’t need to depend on seeing therapists, buying gadgets or taking medications. I hope I offer choice. And compassion, after all you and I could both have chronic health problems – I don’t know you, but I do know myself, and I’ve posted in the past about my own health experiences.

    If you check on my ‘About’ page, and you’ll see that the patients I refer to are ‘typically composites of multiple patients with identifying information changed for the sake of confidentiality.’

    Thanks for taking the time to comment, I hope you visit again.

  7. Do you know what orthomolecular medicine is? You seem to not be familiar with it.

    There is a new field in medicine that involves genetic testing for polymorphisms. One polymorphism involves methyllenetetrahydrofolate reductase. Ortho treats a condition known as histadelia that requires high doses of nutritional supplements. But histadelics need to avoid folic acid as it can raise histamine levels.

    This new gentic testing is also referred to as personalized medicine which means they come up with high dose supplements based on your genetic profile.

    And that is how these mutations or polymorpisms are corrected with high doses of nutritonal supplements.

    Did that book explain how ortho relates to genetic polymorphisms. Maybe that book is already outdated.

  8. Dear Susan
    I’ve just searched Medline using the terms ‘orthomolecular therapy’ as key words and text words. 40 results came up, but many were written either in Russian or Chinese, and there were many duplicate entries. Those that were in English discussed it as an ‘adjuvant’ therapy, and I couldn’t find any RCT’s.
    It may be an emerging field, but so far the evidence isn’t sufficient for me to consider it for myself.
    Again, I would suggest that if good funding is to be used for health care, it would be preferable to use it on therapies that have demonstrable efficacy, not something that has very few scientific studies supporting it.
    Thanks for taking the time to comment, and I hope you visit again.

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