Integrative and allopathic medicine: a skeptical medical student’s rant

It’s no mystery that I am not a fan of CAM (complementary and alternative medicine), and not because I’m a Big Pharma Shill or been brainwashed by exhaustive campaigns by evil corporations. It’s not that I hate herbs, hate Chinese people, and hate things that are different that I don’t understand. The majority of the time I spent in a research laboratory (5 years, including time as a summer student), I spent it doing research into nutrition and functional foods. I worked with people studying the biochemical effects of exercise on health. I understand the role of preventative medicine and lifestyle interventions more than most people and I strongly advocate them. As part of, you know, medicine.

The term “allopathic medicine” was coined by Samuel Hahnemann, who contrasted it with, unsurprisingly for those of you who recognize the name, homeopathic medicine. It’s a derivative term from the Greek word allos meaning other, implying that the treatment opposes the disease, in contrast to homeos (“like”) cures. That homeopathy continues to persist 168 years after Samuel Hahnemann is a farce – that it is presented to medical students without any iota of explanation or critical thought is a tragedy. Observe:

From the AFMC (Association of Faculties of Medicine of Canada) Primer on Population Health, required reading for my class, with the offending phrases bolded by me:

Contemporary Western medicine is increasingly being challenged to consider how to respond to perspectives and treatments other than those of conventional allopathic medicine. One response has been to propose ‘integrative medicine’ as a collaboration between biomedical approaches and other healing traditions, including herbal remedies, manual interventions such as massage therapy or chiropractic, and mind-body practices such as hypnosis. Similarly, the Canadian College of Naturopathic Medicine trains naturopathic doctors who employ natural therapies as well as using the more standard medical diagnostics of allopathic medicine.

Integrative medicine is about changing the focus in medicine to one of healing rather than disease. This involves an understanding of the influences of mind, spirit, and community as well as of the body…
…Whereas allopathy implies opposing the symptoms of disease, homoepathy implies working with the disease by stimulating the body to produce its natural defensive (e.g., immune) responses.For a time during the mid-nineteenth century, homeopathy (treating like with like) was a serious rival to the allopathic approach, but the development of the germ theory gave allopathy a scientific foundation for many of its remedies. However, by the mid twentieth century disillusionment began when, despite advances in ‘the conquest of infectious disease’ hospitals remained full and waiting lists stayed long. This may have reflected a rising demand for care induced by the perception of its success, but the very success of allopathic medicine (along with improved social conditions) enabled people to live long enough to suffer degenerative diseases for which the allopathic approach is less effective. Moreover, the allopathic approach has some undesired consequences including the rapid increases in costs and the large numbers of people with iatrogenic disorders.2 While allopathic remedies are often highly effective, practitioners are also aware that the best cure may be for the patient to simply restore balance in their life and get adequate sleep, exercise, and good nutrition.

Did you spot all the devious false equivalences and straw men drawn there? Did you notice the bait and switch set up with massage therapy being touted as alternative? Integrative medicine is not a collaboration between biomedical approaches and “other healing traditions” – it’s the infusion of pseudoscience into science. There is no need to worry about traditions when designing a treatment program. You figure out what works best, and you use it. We don’t continue to give people radium for high blood pressure simply because some people in the past thought it was a nifty neat-o idea! Notice also the mention of naturopaths as if they were an equivalent but separate kind of doctor, as if drinking powdered deer horn tea had the same level of efficacy as prescribing a statin.

The idea that “allopathic” medicine is focused on disease rather than healing is a ridiculous notion that I am ashamed to see presented by the people who are overseeing the curricula of this country’s medical schools. In my first week here, the concepts of the spectrum from health to disease, the need for population-based intervention, and the need to treat patients as individuals and not diseases has already come up. We’ve also already talked about treatment – but what is the point of talking about treatment if you don’t understand the disease? I mean, it’s all well and good that Mrs. Johnson comes in vomiting blood all over, but I’m pretty sure that thinking hard about being healthy and taking a nap isn’t going to prevent her form going into hemorrhagic shock! Only once you understand the disease can  you design a treatment. If you think her vomiting blood is from possession by an evil forest spirit, you’re going to proceed quite a bit differently than if you realize that Mrs. Johnson has a ruptured blood vessel in her stomach. The whole purpose of medicine is to achieve wellness! No amount of pre-scientific thinking or feel-good nonsense is going to save Mrs. Johnson’s life!

And of course, the criticisms that because “allopathic” medicine works so well, now people are living long enough to deal with issues that it can’t treat. So, when Mr. Wong comes into your clinic, presenting with symptoms of Alzheimer’s, clearly the only answer is to abandon the system that works really well at everything else, and try some random stuff that has no evidence to support it. This is the same sort of tactic that creationists use in the “God of the gaps” arguments. We don’t know, so God did it. We don’t know, so let’s use reiki. The absence of evidence for something does not mean you get to fill in the blanks with your chosen brand of unsupported beliefs. If there is a gap in our knowledge about what to do with an Alzheimer’s patient, we should research into causes (and subsequently treatments) of Alzheimer’s disease. Plausible, mechanism-based treatments. They don’t need to be drugs; there’s been psychological-behavioural research being done into mental training exercises (most of which has come up short in translating to increased everyday functionality.) Maybe we need to do more to prevent head trauma injures like concussions during sports activities. Maybe we should look at how alcohol and drug abuse can lead to dementia later in life. All of these are well within the realm of medicine, and require no magical thinking. They are testable hypotheses and should be pursued. Until we have an answer, you don’t get to fill the gaps with the nonsense du jour.

Did you also notice that homeopathy is given a one-off vaguely plausible sounding mechanism without any sort of definition as to what it might be? They make it sound like homeopathy is like vaccination, dealing with it not only credulously but dishonestly. How many students are going to read that claim, assume it correct, and go on to think that is is a perfectly legitimate form of medicine?

It’s unsurprising that they also bring up iatrogenic diseases, which can be literally translated to mean “healer-caused” diseases. These diseases range from anemia due to excessive blood draws in the hospital, to hospital-aquired (nosocomial) infections, to potentially lethal drug side effects. They are a major issue in medicine, especially when they are preventable, as in nosocomial infections (which can be prevented by proper cleanliness techniques) or worse, when someone screws up. There are failsafes in place for mistakes, and are why hospitals have adopted a team approach, but they inevitably will happen. However, this is not an argument for throwing the whole system, which we’ve already established works quite well. This is an argument for making the system better, for preventing the mistakes, for increasing communication within a team, for finding more failsafe systems, for being pro-active. The system isn’t broken, it’s just not perfect. You shouldn’t replace something that works but has side effects with something that doesn’t work but has none, especially since the lack of side effects are due to the fact that it doesn’t work. 

This is, of course, also assuming that “traditional” medicine has no side effects, which the anti-vaccine crowd has shown us that it can have. Eschewing modern medicine kills people. If people forsake their family physician for a naturopath, they will cannot be given prescriptions if they need them. If Mr. Sullivan is an overweight, 58-year old pencil pusher with genetic high cholesterol and an impending heart attack, then advocating a healthy diet and more exercise is important. But given his genetic preponderance and his previously sedentary lifestyle, no amount of oatmeal will help. In addition to lifestyle counselling, he desperately needs pharmaceutical intervention, possibly stenting to keep his heart’s blood vessels open, and an intensive monitoring of his blood lipids. If he dies of that heart attack, and the naturopath did not refer him to a physician when first line defences fail, that naturopath is responsible for his death. Just as letting someone get hit by a bus because you don’t want to rumple their suit jacket makes your failure to act lethal, so does dependence on pre-scientific thinking while avoiding science-based medicine cause people to die. Naturopathy, at its core, is based on true principles (that we get drugs from the natural world, there’s a science based on it called pharmacognosy), but in practice is little more than hand-waving, placebo-effecting ridiculousness. On the Canadian Association for Naturopathic Doctors, the website linked to by the AFMC’s primer, they recommend for colds & flus:

To aid the elimination of toxins through the skin induce perspiration by taking long hot baths, using an infra-red sauna or steam room. Increasing perspiration through the skin is one of the safest and most effective ways of eliminating toxins.

You know, unless you get dehydrated and die.  I hear that making people who have a fever sweat even more is really sound medical advice. To get rid of toxins. Right.

So no, Association for the Faculties of Medicine of Canada, I don’t think that we should consider integrative medicine and the “treatment of mind, body and spirit” in our practice. A doctor is not a shaman, nor should they attempt to be. I think physicians should be compassionate, caring, understanding, attentive, and open with their patients. They should be concerned for their patient’s autonomy, their mental health, and their feelings. They should strive to give them the best care, based on the best evidence available.

TL;DNR: I don’t think that there is any room, when people’s lives are at stake, for bullshit.

 

Update: Somebody famous read this article and liked it enough to link it on their Twitterfeed! Scott Gavura (@PharmacistScott), blogger of Science-Based Pharmacy and occasional writer for Science-Based Medicine.

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