“Here we go again, Curmudge, tackling a topic on which the
people with real knowledge of the subject fall into two camps. Last spring it was low doses of
ionizing radiation with the linear no-threshold theory vs. radiation
hormesis. Then we talked about
anthropogenic global warming with the consensus vs. the contrarian
perspectives. Now you want to
discuss conventional or allopathic medicine vs. alternative or complementary
medicine? So what is this
alternative medicine stuff anyway?”
“ ‘Any therapy that is typically excluded by conventional
medicine, and that patients use instead of conventional medicine, is known as alternative medicine.‘ Alternative medicine includes use of natural products
(herbs, vitamins, minerals, and probiotics) as well as mind and body practices
(acupuncture, meditation, relaxation techniques, and movement therapies). Julie, if you’d like a detailed
discussion of herbal medicine—including history—check out Herbalism in
Wikipedia. You’ll be pleased to
know that some alternative therapies are scientifically validated, although
some are not. ‘Integrative
medicine combines mainstream medical therapies and alternative therapies
for which there is some high-quality scientific evidence of safety and
effectiveness.’ “
“Wow, that sounds exciting and, thankfully, reassuring. But tell me how, Old Guy, did you get
onto this alternative medicine kick, anyway? As I recall, back on 9/23/10
we began a five-posting series on Evidence-Based Medicine. That’s as main stream as medicine can
get.”
“Right after we finished that series Mrs. Curmudgeon was
diagnosed with an interstitial lung disease. The pathologists could not agree on whether it was a treatable
or terminal form. Hoping it was
treatable, prednisone—with all of its side
effects including a lowered resistance to disease—was prescribed. Then while studying the medical
literature, I saw an ad for a purported alternative treatment. I asked the doc, ‘is this snake
oil?’ His reply was, ‘probably.’ At that point I decided that the
alternative med might be a viable last resort.”
“I remember, Curmudge, that Mrs. Curmudgeon contracted
pneumonia an top of the interstitial lung disease and died within a month. There wasn’t time to take her to Mayo’s
or implement any sort of Plan B.
In retrospect, the alternative med could not have done any less for her
than the prednisone. You were
devastated.”
“And I still am.
The thought occasionally crosses my mind, ’we might have saved
her.’ So that, Jaded Julie, is why
we are talking about alternative medicine.”
“As I suggested earlier, Curmudge, it seems that that we have
come upon another of those two-camps issues like global warming. And members of each camp use extreme
examples in describing the ‘other guy,’
The alternative medicine docs accuse the conventional or allopathic docs
of being in cahoots with ‘big pharma.’
In reply, conventional physicians accuse natural medicine purveyors of
being ‘quacks’ making big profits from gullible patients. While in reality, all the patient wants
is to feel better or be cured irrespective of the source of the medication.”
“Right as usual, Julie. You and I are learning enough to give our readers a modicum
of knowledge of the differences between the two main types of medicine and some
guidance on where they can learn more.
That’s about all we can hope to do in a blog.”
“Before we get too deep into this stuff, Old Guy, please briefly
tell me more about the differences between allopathic and alternative
medicine.”
“Let’s start with allopathic. A person with an illness goes to her primary care
physician—an MD or DO—is diagnosed and given a prescription. She takes it to a pharmacist who
dispenses an FDA-approved medication.
The med is most commonly a synthetic organic compound developed by a
major pharmaceutical company based on their knowledge of the cell biology and
biochemical pathways impacted by the disease. If the disease is cancer, the compound (not always
synthetic) is called chemotherapy; and it’s in a race to kill or arrest the
disease before the side effects of chemotherapy kill the patient. Our series on The Ordeal last February described the
torments of chemotherapy, but it seems to have cured my friend of his
non-Hodgkin’s lymphoma.”
“Thank God for that, Old Guy. So if allopathic meds have FDA approval to attest to their
safety and efficacy, what comparable assurance do we have for alternative meds
extracted from natural products?”
“That’s one very important issue that we’ll consider in
detail later, Julie. For the
moment, we can derive a little bit of confidence from the experience of ancient
Greek, Chinese, Arab, and other practitioners over a thousand or more
years. If these ancient healers
didn’t achieve some success, they
would have become unemployed or possibly burned as witches.”
“Okay, Curmudge, why don’t the formulators of modern
alternative medications do the necessary testing of safety and efficacy and
obtain FDA approval? Then their
preparations would be designated conventional medicine.”
“More and more testing is being done, Julie. However, most of the makers of
alternative medicine preparations are not major corporations, and Phase I, II,
and III clinical trials
are very expensive to conduct.
Additionally, for a double-blind study, it may be difficult to design a
placebo (sugar pill) that looks exactly like an herbal concoction. Perhaps the best route for a little guy
with a potential blockbuster drug is to be acquired by a major pharmaceutical
company. Of courser, some
purveyors of alternative meds are already making sufficient profit that they
might consider conducting trials and seeking FDA approval to be not worth the
trouble. And finally, some others
feel that if an alternate therapy is not based on a plausible
scientific mechanism, a clinical trial is not appropriate. After all of that, use of an approved
‘miracle drug’ is never a sure
cure for an individual patient anyway.”
“I have an idea, Professor. We’ve talked a lot today, and it’s time for a cool one
(glass of water). Perhaps we
should assign Wikipedia’s excellent introduction to Herbalism as a
homework assignment for our readers.
Then we’ll move on to searchable databases in our next session. Also, you neglected to mention the Mayo
Clinic’s comprehensive and authoritative Book
of Alternative Medicine. (1) ”
“Jaded Julie, what would I do without you?”
Kaizen Curmudgeon
(1) Mayo Clinic Book
of Alternative Medicine, 2d ed. (2010, Mayo Foundation for Medical
Education and Research)
Link to posting from blog archives: Patient Safety—Medications 1/08/09
No comments:
Post a Comment