Angry Doctor

Thursday, May 25, 2006

"There is no such thing as alternative medicine"

As expected, Dr Crippen blogs about Prince Charles' campaign to promote alternative therapies in the NHS (May 24 entry).

One thing he wrote impresses me:

"There is no such thing as alternative medicine. There is only medicine."

The so-called "western" medicine is in fact itself an 'integrated' and 'integrating' system. A lot of what was traditionally practiced in the west had been abandoned, and a lot from other traditional systems have been integrated.

The logic would have been plain enough: if it worked, we take it and/or keep it. If it didn't, we junked it.

Western medicine took what it considered was good, and integrated it into its own system with a unifying language.

I rather like the language we use in western medicine. Not the daily clinical one, but the one involved in the basic sciences. We talk about molecules, electrons, cells - same sort of language used in everyday science that helped make your TV, microwave oven, and launch men into space.

Electricians all over the world will talk in terms of voltages and currents, but when it comes to the matter of health, we speak in many different languages.

So do we cling to our different languages because they make us feel different and special, or are they truly integral to our treatment?

Afterall, if a certain therapy works, it should work no matter what you call it.

Certainly there are cultural differences and traditions involved in alternative therapies, but it seems to me that if practitioners of alternative medicine truly want more patients to benefit from their treatment, perhaps a better way to do so would be to let their traditions be interpreted in the language of science.

Diversity of languages is fine for literature and the arts, but if you have something worthwhile to share, wouldn't you want it to reach as wide an audience as possible?

Just as a form of therapy should not be rejected simply because it is 'alternative', the language surrounding a therapy shouldn't be insisted upon simply because it is 'traditional'.

Sure, it's just a paradigm thing and you can argue for western medicine to be styled in that of another tradition.

But this paradigm is one that built the computer you are reading this on.

Labels:

posted by angry doc at 5:10 pm

25 Comments:

  • I have a question for you angry doctor. How much do you know about medicine outside of western allopathic medicine?

    Actually I mean no malice when I say that, but one of the reasons we are having the problems you outlined is that the various different "Races","Religions","Nationalities" of medicine do not know much about each other.

    The "Christians" of medicine tell the Buddhists to speak in the language of God and Jesus, the "Hindus" of medicine tell the Muslims to speak in the language of Shiva etc.

    Personally I do know a bit about some other schools of medicine, but not all. Heck I've even read about Auto-urine therapy!

    The point of the matter is that if you did read into these schools of healing, you'd understand why it is not possible for them to speak in the "language" of western allopathic doctors. For example TCM is based very much on philosophy rather than science. One can understand why this is so because all the basic principles of TCM were established over 5000 years ago where no one had even heard of science! But I must say the philosophy was powerful enough and the associations they made correlate well on many instances with science as well. To ask them to explain TCM in science is like asking western medicine and science to go philosophical. It's a tad bit unfair.

    I feel the key to all this will be mutual understanding, tolerance and an effort to work together.

    Many would feel that western medicine is superior to all the other schools of healing and it may well be true at the moment where we live in a very scientific world, but it was not always like this. Similarly there are many unsolved medical mysteries and problems that may push scientists to look into "alternative medicine" to find inspirations to conduct research to validate and invent new successful treatments.

    TCM professors are now trying to explain TCM with science, but if you understand TCM, you will know that there are many concepts that simply cannot be proven. Just like western medical science has still been unable to explain many mysteries of Life.

    But instead of waiting for the TCM professors to "prove" themselves to us, what's stopping us from learning about TCM ourselves? I know most doctors would say, "Why waste my time on all this unproven theories? I have better things to do."

    Well then that's a personal choice. But we can then see why there is a problem. Sometimes it isn't just the fault of "alternative medicine" itself. We might want to look at how we view things ourselves.

    By Blogger Dr Oz bloke, At May 26, 2006 12:04 pm  

  • Medicine is not a religion - the results are visible now and we do not have to await an afterlife to see who is 'right' or 'wrong'.

    And the language of 'western' medicine is not the language of 'western medicine' - it is the language of science.

    And while dealing with patients may be an art, treating diseases is a science. No amount of art will make an ineffective therapy effective.

    TCM may be steeped in Chinese traditions and philosophy, but if the facts behind them are true, they will work even if you express it in modern scientific language. A herb with an active ingredient to treat a disease will treat that disease even if you assign it some Latin name.

    If you accept the above to be true, then why cannot TCM be expressed in scientific language without its philosophy? Why can some concepts not be proven?

    I agree that different disciplines of medicine should work together for benefit of patients, and western medicine has already taken the first step to provide a platform to do so by expressing itself in the language of modern science. It has abandoned concepts like phlegm, melancholia etc. to adopt a language which is in use not just in western medicine, but also in everyday science. So why do alternative medicine disciplines want to set themselves apart as 'alternative'?

    By Blogger angry doc, At May 26, 2006 12:54 pm  

  • Actually from what you write about TCM it is quite clear to me that you do not know very much about it.

    Herbal medicine is one aspect of TCM. But it is not the only aspect of it. Acupuncture? Meridians? Qi? Yin and Yang?

    Anyway I don't blame you. When I started out as a medical student and later as a young doctor, I was also very skeptical about all this "alternative medicine".

    But one day I decided to read about it myself and learn more about it myself. We both probably agree that Western Medicine is veyr differnt from alternative medicine eg TCM.

    If you wanted someone to translate Japanese into english, don't you think you would prefer to have a native english speaker who knows Japanese to translate for you or a native Japanese speaker who knows English to translate to you? You might get different interpretations. But you would probably want the former right?

    Similarly, if you learned about alternative medicine, you would understand why the TCM or alternative medicine practitioners are having such a tough time translating. Simply put they don't know "English" very well!

    My aim is not to declare which school of medicine is superior. But the take the best of each school of thought and apply it such that we can get the best for our patients. In fact we as "scientific" doctors are best positioned to read, analyze and explain to patients what out there is truth, half-truth or plain lies.

    You'll be surprised when you learn more about alternative medicine.

    One field you can try looking into is Nutritional medicine. That is by far the closest "scientific" "alternative" medicine field. There are many papers written about such stuff. And I believe I have linked some to you before.

    But other fields like homeopathy, TCM etc.....well they are very "unscientific". But it doesn't make it ALL totally BS.

    Have a look and read a bit. We don't have to agree with everything we read. But the point is to read. I find patients not stupid either. When we blanket say that all TCM or alternative medicine is BS, they also know it is probably because we do not know anything about it.

    But nowadays when I discuss things with my patients and correlate certain TCM principles to their problems, they are happy to listen and discuss about the various treatment options (both western and TCM). Sometimes I tell them although TCM says this, we know scientifically that is due to this. And they are happy to accept that argument because we go through the thought process and discuss things based on both principles rather than just sweeping TCM or other alternative medicine principles aside.

    I hope you get what I am trying to say.

    By Blogger Dr Oz bloke, At May 26, 2006 1:15 pm  

  • The whole idea in the end is to have INTEGRATED medicine.

    I have a friend who said this "As long as it works for the patient,and is safe, who are we to deny them the treatment?"

    And there is some truth to it. Some "scientists" would say some of these benefits are "placebo effects". Well even if it is, the patients still got improvements. But frankly, I don't think it's all placebo.

    Acupuncture for one, has NOT (I repeat, NOT) been able to be proven scientifically. But yet we have seen the results of acupuncture being something more than just placebo. They can anaesthetize patients well enough to undergo ops that need GA!

    In my class, some other doctors have asked, what is a meridian? A vein? A nerve? A lymphatic vessel? Well the short answer was that it is the sum of all of the above and much more. Too mumbo jumbo for scientists? I can see why. It's more philosophy than science!

    Anyway it is very hard to speak and debate about things if one party has not much background knowledge about the topic in the first place.

    It is just like explaining to an uneducated old patient about diabetes, insulin, pancreas, HBA1c etc when he is more familiar with the theory about Diabetes being a condition of excesive heat or blockage in Qi. Great difficulty and much resistance! Well we used to blame the patients, but strangely you can correlate some things such that they sound "right" to the old folk in his "language". Eg sugar is acidic, hence it is "heaty" so eat less,medicine helps to cool you down, nourish the Liver Qi etc? Something like that.

    So I can perfectly understand why this "divide" between western medicine and "alternative medicine" will continue because western medicine persists to challenge alternative medicine to "prove" itself to western medicine first before they even look at them.

    If you were alternative medicine and had been around LONGER than these western medicine guys, what would you think? Why do I have to prove myself to you?

    Ah....when both parties refuse to budge....then there is no progress isn't it?

    By Blogger Dr Oz bloke, At May 26, 2006 1:27 pm  

  • I think we understand each other's position.

    You believe it is not necessary for all medical disciplines to adopt the same language.

    But do you believe that it is not *possible* to express all medical disciplines in a common scientific language?

    If so, why not?

    Why should something which works not be scientific, or be provable?

    I choose to base my practice (or the background of my practice) upon science, which is not to say that alternative therapies all do not work, or that I will (or can) stop my patients from seeking alternative therapies.

    By Blogger angry doc, At May 26, 2006 2:20 pm  

  • "But do you believe that it is not *possible* to express all medical disciplines in a common scientific language?"

    I believe that it is NOT possible to express ALL medical discipline in a common scientific language simply because science has not addressed and answered EVERYTHING in our world. There are still mysteries that science cannot explain. Don't you agree? So perhaps one of the problems is also that science has not come to a level where it can explain and understand certain aspects of our world.

    Anyway your question is not easy to answer fully from such a blog/comment type interaction , plus with your relative absence of understanding of alternative medicine it makes it very difficult,but I will certainly try to elaborate.

    Interestingly one of the topics for my tutorial discussion this weekend is "The significance of philosophy in Western Medicine and TCM"

    On first look, I asked myself, Western medicine and philosophy? What philosophy? It's science! But then the roots of medicine did not start out as science all the time. Hippocrates was no scientist. He is known as a philosopher. Galen who introduced anatomical analysis of disease was also more a philosopher than a scientist. In fact philosophers of old were the "scientists" today but they lacked the scientific methods we have today.

    I did some reasearch and found that modern western allopathic medicine is based very much on Rene Descartes' work called "Cartesianism", a philosophy characterized by its rationalistic, dualistic worldview. An unintended consequence of Cartesianism was the seperation of "mind" from the "body". This ultimately led towards the work in various fields of specialization in working otu pathways of how different organ systems operated seperate from each other and the body much less the mind.

    Louis Pasteur's "germ theory of disease" fit in well with Cartesianism as well. It also led to researchers focusing on treating specific aspects of illness eg symptoms rather than concentrating on the individual's balance of health and harmony.

    Western medicine focuses very much on anatomical systems eg we classify diseases based on the specific anatomical organs. We name them arthritis, tonsilitis, appendicitis, heart diease, colitis, prostatitis etc. We also name cancer by the organ that is affected. So western medicine is very much focused on physical structural anatomic systems.

    From what I have read and learned about TCM, the systems TCM refer to are not simply anatomical structural
    systems but also functional systems. Eg the Liver system in one term refers to aspects of the gastrointestinal system, hematological system, endocrinological systems in western medical terms. But it's simply called "The Liver system". Hence it is quite confusing to many doctors. But we all know that the Liver has got many functions.

    Which is why TCM tends to have a more "holistic" view of disease and the body. Now this may be good in certain situations but it may also be bad in some cases. Sometimes it is better to isolate and focus on a problem and resolve it, rather than go through so much linkage here and there and ending up nowhere. On the other hand for some very vague presentations where several systems may be affected but not affected to the extent that western science can pick up abnormalities in a particular organ, this TCM philosophy may be useful. It's a matter of choosing the right tools for the right work.

    Now TCM is very rooted in spiritual thinking and philosophy. The concept of Qi itself is worth discussing for over 6 hours as other classmates of mine will attest to. Yin Yang is another. But they have been able to be "somewhat" expressed with science in the fields of thermodynamics, astrophysics etc But then again some of these "science" are concepts that even we so called "scientists" do not know because it is outside of the field of medicine!

    All I can say is that TCM and western scientific medicine went in different directions.

    TCM went into spiritual thinking. Observing humans and disease and then linking it to nature. For example the Liver is associated with "The Wood Element". Trees are supposedly growing and branching. The liver has similar morphology. Trees also grow best unhindered. Similar to what the liver organ prefers. Nevertheless I can understand the skepticism when we link Liver and Wood.

    But then when we consider the other organ systems. Fire - Heart and Small intestine system, Earth - Spleen and Stomach system. We can see some correlation with western medical science. Of course we must remember that these systems by TCM standards refer to the functional systems more than structural. In other words I find that the TCM linked the Liver with the right areas even by Western Medical terms. And they explained this by Wood being the "mother" nourishing fire (wood feeds fire) the "child" and being the "master" of Earth which is the servant (trees grow over earth and hence control earth)

    It's probably quite confusing for you.

    But the point I want to make is that TCM does make sense from a philosophical point of view. But we must make some assumptions. Eg that the liver system is associated with Wood. TCM also goes against western medicine directly by saying that emotions influence the systems directly. Whereas no western doctor would say that if you are angry your Liver can be affected!

    Scientifically we can prove some TCM principles already. But we cannot explain all of it.

    But with western medicine it is also similar in the sense that philosophically, we assume that the individual parts of the body can work independently (unless we prove that there is a link scientifically later but which comes first? the proof or the theory?) of each other and independent from the mind. That was how we developed Western Medicine. And then we used science to rationalize it.

    TCM went in another direction. A spiritual one. And persisted in using philosophy to rationalize it.

    Can we then describe something that developed so spiritually and philosophically in scientific terms? It is possible but probably not soon. The key I think is getting both sides to read and learn each other's language and then work towards a common explanation together.

    In a way it is like trying to scientifically express religious faiths. Or to scientifically explain the feelings and emotions one has for their loved ones.

    Very difficult. But I think alternative medicine and western allopathic medicine will eventually find a common ground but it might take a few hundred years.

    One thing to note is that western medicine has very poor results with the cure and control of chronic diseases. I do not know much but I will learn more and see if TCM really has concepts that can help such patients with chronic diseases.

    I have tried my best and I don't expect to win anyone over. But the idea is to just introduce some element of doubt and possibility into minds. After that, it's all up to us to pursue the answers ourselves. It happened to me and I'm still trying to learn more. But at least it got me going.

    The worst of course is to sit back and be a skeptic without investigating for yourself.

    By Blogger Dr Oz bloke, At May 26, 2006 3:37 pm  

  • Yes, certainly not all things can be explained by science - some because they are false and have no scientific bases, and some bacause science have yet to catch up with them (like the way we all thought the Force was some mystical power, until Episode I showed us it was measurable in your bloodstream...). In either case, I am not willing to base my practice on them.

    Modern science is considered a type of philosophy by philosophy, but it differs from other philosophies in that it has practical 'mechanical' usage (as opposed to most other philosophies being 'science of living', 'science of knowing' etc.) No other schools of philosophy has launched a rocket, and I am willing to bet that when China launched a man into space they relied on physics and not ying-yang and five elements.

    We are discussing things which have empirical realities, not religion or emotions here.

    You yourself have noted that many aspects of TCM may be explained or correlated in scientific terms, and you are willing to adopt these (and perhaps also those which have yet to be correlated?) into your practice.

    That is a personal choice to a certain extent.

    But the original point of the post was about alternative therapies (not just TCM, and most are not as reputable as TCM) and whether unproven therapies should be funded using public money.

    Certainly if it was private money no one really cares what therapy you went for as long as no one gets killed or maimed.

    The second point concerns the point of licence (not just the paper, but the concept). Our licence to practise is bound by many conditions, in the forms of laws, regulations, and guidelines. In our enthusiasm to integrate medical disciplines, we must not forget that what we can practise is not the same as what we may practise.

    By Blogger angry doc, At May 26, 2006 4:34 pm  

  • "But the original point of the post was about alternative therapies (not just TCM, and most are not as reputable as TCM) and whether unproven therapies should be funded using public money."

    Sorry, that is the original point of the *previous* post.

    The point of *this* post is whether alternative medicine should be expressed in modern scientific language for better acceptance.

    By Blogger angry doc, At May 26, 2006 5:11 pm  

  • And as I pointed out to you. Nutritional medicine is part of alternative medicine that I recommended you read more about.

    There are various papers and research that validate some of the concepts.

    But even then it is rejected by western medicine. Remember H Pylori? Well the guys who were so ridiculed later won the nobel prize. If you read the older alternative medicine books, they were calling elimination of H pylori for PUD "alternative medicine".

    Remember what I linked about Hyperinsulinism and Raised Homocysteine levels published in NEJM?

    Well this is considered "alternative medicine" as well.

    Anyway at the end of the day, nobody is asking us to base our pratices on alternative medicine. We are primarily western medicine doctors. But we can use some of these "alternative medicine" to complement our practices. What we choose to use and what we don't is up to us, and we are resposible for it subsequently.

    Trust me, when you help the patient who has been having chronic cough for 1 year to actually resolve it using "alternative medicine" and she thanks you for it, you'll understand what I mean.

    But it's not wrong to say I do not want any of it in my practice. It's a personal choice.

    The question of course is when you have money from the government to spend on healthcare, who's the one who chooses what kind of doctor they want to go to? The government? The western doctors? Or the patients themselves?

    If the patients want to see alternative medicine doctors for conditions western medicine was not able to treat, do we actually have a Moral Authority to say no to them? Especially when we know absolutely nothing about alternative medicine?

    For example you mention facts and lies. Well how do you know without investigating? One part of the whole point I was trying to make is that you don't need to practice alternative medicine, but at least knowing more about it, helps you better discern what is fact, half-truth and lies. At the moment, most western doctors treat ALL alternative medicine as lies. Be honest, you are inclined to think that way too aren't you? Whatever we don't know, it's better to advise patients against doing it. Simple, Safe.

    Learning and reading about alternative medicine does not mean you have to practise it. At the same time, even if you wanted to practise it, what makes you think you are good enough to do so? Is your training adequate? Will patients trust you to do acupuncture on them as a self trained acupuncturist?

    Which is better : Ignorance or knowledge even if it is later found to be false? I think it makes us all the more richer no matter what it is.

    But of course it is a personal choice, only thing in the NHS example, the western doctors are trying to restrict patients from having that choice.

    Just food for thought.

    By Blogger Dr Oz bloke, At May 26, 2006 5:36 pm  

  • Here's an interesting thought.

    In reality we have seen many patients who were told that they had no hope of a cure by western doctors. Rather than resign themselves to the fate, they opt for alternative medicine.

    Now most of these people don't recover. But they would rather take th e chance and have hope. Some of them do recover!

    Some of these patients are actually doctors themselves. Some have children who are doctors.

    Basically what's there to lose to try? Especially if it isn't dangerous and harmful?

    As it is do you know how much money the NIH in USA is pumping into research for alternative medicine? I think they are trying. But as we have discussed not all things will be able to be explained with randomized controlled trials simply because the human body is too fluid a concept to really eliminate confounding factors due to individual variations. We have reached that stage of research where it all becomes that fine in details.

    Give it some time. The journey has only just started to begin.

    By Blogger Dr Oz bloke, At May 26, 2006 5:44 pm  

  • I don't think all of alternative medicine are lies. Certainly some if not most of it must work, but the 'scientific method' means we must have a resonable hypothesis of how it works, and we must have evidence that it works.

    For H. pylori to be acceptabed as science, it too had to be subjected to the scientific method.

    Just because one 'alternative' therapy is proven to be true does not mean all alternative therapies are ture. And vice versa.

    What the scientists were against was not NHS funding alternative therapy, but a blanket promotion of all alternative therapies without regard for evidence. That is something at a policy level, and I tend to agree with them.

    On a personal level, I am not advocating not examining alternative therapies and a blanket denial of them - in fact I am advocating examining them using the same scientific methods we use to examine western medicine.

    As I said I won't and I can't deny patients alternative therapy, I won't comment on them in my capacity as a western medicine doctor.

    By Blogger angry doc, At May 26, 2006 6:07 pm  

  • "As I said I won't and I can't deny patients alternative therapy, I won't comment on them in my capacity as a western medicine doctor."

    You do realize that many doctors share your approach to this as well.

    The problem with that is that the patients themselves lose out on having their personal doctor "investigate" things for them. Who is better positioned to comment on alternative medicine that our patients are interested in? Us western docs or our patients who don't know much?

    If a patient asks me to check something out for them. I do so. The internet is a rich source of information anyway and it's free. Pub med extracts are available too. There are various books sold in bookstores abotu various different types of alternative medicine.

    If it's very mumbo jumbo, I tell my patients what I think. And I tell them that is not something I would do myself. But I tell them it's my personal opinion based on what I know as a doctor and what I have read about the therapy. Patients will understand you're no expert but at least they will take your opinions as a medical professional familiar with the body, physiology etc to help them decide if the therapy is right for them.

    So what would you prefer? Tell the patient "Sorry I don't comment. It's up to you." or "I am no expert but from what I know, this therapy A is about this and that, and it is good for this and that based on this and that, but may not be so true because of this and that, having said that I would try it if I had that problem (or I would not try it if I had your problem), but at the end of the day, it's up to you"

    Which is better to have an opinion or no opinion?

    In all honesty I think most doctors would give an opinion. But unfortunately it will be a negative one borne out of ignorance and doubt rather than an assured opinion.

    Of course the counter is that we risk the danger of "endorsing" alternative medicine irresponsibly. Well that really depends on the doctor-patient relationship/trust.

    Easy way out. Say no comment. Say I don't know so better don't take. Or it's all bogus so better don't take.

    Sometimes patients should also understand it's not easy for us doctors too! :wink:

    By Blogger Dr Oz bloke, At May 26, 2006 6:22 pm  

  • I see your point.

    To me the main difference between our knowledge of western medicine and our knowledge of alternative therapy is that we are trained and accredited in the basics of western medicine, and we are also trained in continual learning in western medicine. We know where to look for the latest information and papers, and we know how to tell if some papers are just drug-company propaganda.

    I cannot say the same about my knowledge of alternative therapy from what I read on the internet and find in a bookstore.

    The TCM course you are undergoing will give you the 'official' grounding in understanding TCM, so that will be different.

    I see my relationship with my patients as 'strictly professional', with the emphasis on 'professional', and I avoid imposing my views on things not within my professional training and learning on them.

    (I do have views on alternative therapies - acupuncture works, magnet therapy sounds quacky - but I am not about to let my personal views influence my patient's choices.)

    I do advise them against having their fractured limbs massaged by sinsehs though. :)

    By Blogger angry doc, At May 26, 2006 6:41 pm  

  • "On a personal level, I am not advocating not examining alternative therapies and a blanket denial of them - in fact I am advocating examining them using the same scientific methods we use to examine western medicine."

    Firstly let me say that I agree that as far as possible we should TRY to express alternative medicine into scientific terms. This is the basis for which we gauge reality today. And that should be the ultimate aim. But we must acknowledge that it is very difficult and possibly impossible to do it comprehensively.

    Actually I have heard an interesting point of view with regards to your above comment.

    You would agree that it would take some time for scientific methods to validate or investigate alternative medicine. It takes time.

    So what do we do while they are working it all out? Deny the patients the treatments? What happens if it turns out it was good stuff? And we were denying patients that? Can governments be sued? On the other hand if it turns out it was all fake, can the governments also be sued?

    Consider Aspirin.It is interesting that Aspirin had been around since the 19th Century. Felix Hoffmann developed the drug in 1897. But looking even further back, Hippocrates himself was prescribing "willow bark" containing "salicylic acid" for relief of pain!

    In 1948 Dr Lawrence Craven an American doctor observed unusual bleeding among children who chewed an aspirin gum to ease pain after a throat operation. Doctor Craven believed they were bleeding because aspirin prevented the blood from thickening or clotting. He decided that aspirin might help prevent heart attacks caused by blood clots in blood vessels.

    In the Nineteen-Fifties, Doctor Craven examined medical records of about eight-thousand people. He found no heart attacks or strokes among those who regularly took aspirin. Doctor Craven invited other scientists to test his ideas with modern methods. But, it was many years before large studies were carried out.

    Finally in 1971 John Robert Vane, who was then employed by the Royal College of Surgeons in London, showed that aspirin suppresses the production of prostaglandins and thromboxanes. And in so doing proved Doctor Craven's theory to be scientifically correct. John Robert Vane won the Nobel Prize in 1982.

    Many patients had started taking aspirin to prevent heart attacks even before 1971. But the USFDA only approved Aspirin for the treatment and reduction of risk of stroke in 1980, some 32 years after Doctor Craven's observations.

    You can read more by doing a yahoo search on History of Aspirin, Lawrence Craven or go to this site
    http://www.buywobenzym.com/
    A_Balanced_View_of_Aspirin.htm

    I wonder how you would have felt as one of those heart patients who were told during the 1950's that Aspirin for heart attacks was bogus because there was no science to prove that! Only to find out 20 years later that those "quacks" were correct!

    So what do we do for people in the meantime? Remember that Aspirin did cause gastric erosions and side effects of GI Bleeds and I am sure many gastroenterologists must have been cursing those "Aspirin believers" during that time.

    History tells us of possibilities like this. Thus it makes it difficult to make a proper decision based on an uncertainty.

    What can we do?

    Tough questions.

    By Blogger Dr Oz bloke, At May 26, 2006 6:56 pm  

  • "I cannot say the same about my knowledge of alternative therapy from what I read on the internet and find in a bookstore.

    The TCM course you are undergoing will give you the 'official' grounding in understanding TCM, so that will be different."

    Frankly, what's stopping you from reading authoratative texts in various alternative therapies?

    Must one attend a course to get the "necessary grounding"? I read the textbooks and they say similar things as to what the lecturer says.

    Many books out there are written by medical doctors, with cross referenced research papers in the reference section.

    What some doctors do is that they read the book, then they go look at the various papers listed in the "references" section and search for the papers and read them. If the author of the book is pulling a fast one, you will know because of the poor quality of the referenced papers. But sometimes you see for yourself all the papers in the NEJM, JAMA, BJM and you read them and go..."hmmmmm....."

    As you said we are taught how to discern and analyze from our university education. We should not be waiting to be force fed information and concepts by some "official" course. But we should go out there and investigate for ourselves. Think. Analyze. Discuss. Debate. That's what learning is about.

    It's very commonplace however for us to only listen when we already feel or "know" something to be the gospel truth.

    What book on alternative medicine have you read?

    By Blogger Dr Oz bloke, At May 26, 2006 7:06 pm  

  • From a legal point of view, one cannot be faulted from practising 'best practice' and 'current evidence'.

    You argue for 'alternative' therapies which later on became proven therapies, but of course there are many alternative therapies which will not become proven practice.

    Given that resources do not permit ALL alternative therapies to be tested here and now, the solution is to test those which show most promise.

    Science, as you said, takes time. But against endorsing and funding all alternative therapies before they can be tested, it is time well-spent.

    Let us endorse and fund those we know to be effective, while we continue to test other therapies.

    By Blogger angry doc, At May 26, 2006 7:08 pm  

  • "Let us endorse and fund those we know to be effective, while we continue to test other therapies."

    Strange. If you already "know" it to be effective, why waste money to "validate" it? Merely for the sake of officially calling it science?

    Of course the offshoot can be new directions in research that can be taken eg eicosanoids from Prostaglandins and Thromboxane which started from Aspirin.

    But there is a bit of a contradiction there if you ask me.

    As it is I think the market itself knows what works and what doesn't. Why would patients continually go for a treatment that does not work? Would you keep buying Sony TVs if they showed no picture? Or take Panadol if each time you took it you had no pain relief or analgesia?

    We know something already does work for many alternative medicine therapies.

    The way you put it makes it sound like we should also test those that we "know" do not work.

    Anyway I do get what you are trying to say. But as it is I think there are no easy solutions. On the other hand I would want to get involved in alternative medicine by investigating it myself, reading more and learning more rather than wait for science to catch up and educate me.

    By Blogger Dr Oz bloke, At May 26, 2006 7:16 pm  

  • You might want to check out :

    http://consensus.nih.gov/1997/
    1997Acupuncture107html.htm

    That's the link to

    Acupuncture

    National Institutes of Health
    Consensus Development Conference Statement
    November 3-5, 1997

    Interestingly under
    "3. What Is Known About the Biological Effects of Acupuncture That Helps Us Understand How It Works?"

    They write "Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points," the definition and characterization of these points remain controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and other related theories, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture."

    I think NIH will be the one who will eventually do the reconciliation of alternative medicine with western medical "evidence based" approaches to validating treatments, if they do succeed.

    Let's hope we get the answers sooner than later.

    By Blogger Dr Oz bloke, At May 26, 2006 7:54 pm  

  • "What book on alternative medicine have you read?"

    I have read a few Chinese-language books on TCM and acupuncture, and a few on reflexology and herbalism and 'super-foods', and browsed some sites on alternative medicine. I find the absence of a common language a barrier to understanding or accepting their concepts.

    It is one thing to read for your own personal enrichment, but another to incorporate something into a profession which you are not licensed to practise.

    You like to investigate and explore for yourself, while I prefer to lag behind and receive. I am quite old-fashioned when it comes to my practice. :)

    "If you already "know" it to be effective, why waste money to "validate" it?"

    What I mean is we should advise our patients to undergo proven therapies and that the government should fund/subsidised proven therapy.

    Should say the MOH spend money to subsidised certain patented drugs proven to improve outcome in a certain chronic disease, or should the money go towards researching a yet unproven therapy? I suspect you and I will have different answers to that question, and that MOH's choice will not be based on the same considerations behind either of our answers. :)

    "As it is I think the market itself knows what works and what doesn't. Why would patients continually go for a treatment that does not work?"

    Science does not just seek to know what works, but also how it works. Take the example of antelope horns used as antipyretic. We could have carried on killing antelopes by the herd to get their horns, or we could have investigated and found that the active ingredient in the horns came from a plant which they ate which became deposited in their horns. We can then extract the ingredient, put them into little pills, and spare the antelopes their lives and the poor patients from having to grind and boil their horns.

    By Blogger angry doc, At May 26, 2006 8:23 pm  

  • ANGRY!!!

    WHY DO YOU BOTHER?!!

    By Blogger blinkymummy, At May 27, 2006 2:01 am  

  • Er... because I think antelopes are cute and we shouldn't kill them?

    By Blogger angry doc, At May 27, 2006 8:10 am  

  • "It is one thing to read for your own personal enrichment, but another to incorporate something into a profession which you are not licensed to practise."

    I totally agree with you.

    However I find that patients tend to ask questions that pertain more to TCM or alternative medicine rather than western medicine.

    I used to get irritated by such questions, mainly because I had no idea what the answer is! And I'm supposed to be the doctor. Then I told myself that it is the people who ask the questions who don't know what they are asking not me.

    Later on I realised that these questions are here to stay. And I was curious. So I started to read for myself. While I cannot answer it totally, I at least know which "school" of medicine that question should be addressed to. Some patients were happy enough knowing that it was a TCM related question, or a nutritional medicine related question, or a supplement based related question etc etc. I could at least point them in the right direction.

    After some time I finally realised why we have more people asking us questions pertaining to alternative medicine vs conventional western medicine.

    The answer : Marketing.

    MLM, grandparents, old wives tales, pharmacy sales assistants etc. They do a much "better" job talking to people and patients about health matters than HPB or doctors do. Unlike the west, we do not allow pharmaceutical companies to advertise. They can be a rich source of "health education" on TV and in media for the people too. But we don't have it. Instead the people are more likely to be exposed to non-medical professionals talking about alternative medicine concepts.

    And some of these people even ask the customers to ask the doctor why (when they dunno the answer themselves).

    Personally I feel that as doctors we have a responsibility to try our best to guide our patients as far as alternative medicine choices are concerned. Sometimes it is also for their own safety. On the other hand, patients today are less likely to take advice that says "Don't take ANYTHING else for your problem other than the medicine I give you" Patients want to know why. They want to know how.

    Patients are inquisitive "scientists " themselves. The only problem is that they do not know how to interpret the information. And if we doctors can't interpret it either, who else can they turn to?

    Bottomline is, I still think a western medical doctor is in a better position than laymen to interpret the information from alternative medicine.

    Somewhere, somehow, someone has to guide the patients. Why not us?

    By Blogger Dr Oz bloke, At May 27, 2006 9:33 am  

  • Hi angrydr,

    Your example of the antelope horns is actually what the pharmaceutical companies want to do!

    Synthetic drug analogues of antelope horns! New drug. New patent. Tamiflu anyone?

    Which is why so much money is being pumped into alternative medicine at this time :wink:

    You are very right that everyone will have different considerations and reasons when deciding funding etc. Governments, businessmen, doctors, patients, etc

    It's a highly political issue.

    But I agree, we should not kill antelopes if we don't have to. But then again, what happens if the drug turns out to be many times more expensive than the horns from the herbal medicine shop?

    Tough choice. Depends who you are isn't it?

    By Blogger Dr Oz bloke, At May 27, 2006 9:40 am  

  • "Patients are inquisitive 'scientists' themselves. The only problem is that they do not know who to interpret the info. And if we doctors can't interpret it either. Who else can they turn to?

    Bottomline is, I still think western medicine doctors is in a better position than laymen to interpret the information for alternative medicine.

    Somewhere, somehow, someone has to guide the patients. Why not us?"

    Well spoken! Dr Oz, I for one is guilty of asking lots of questions pertaining to my medical conditions and sometimes my doc can't answer them - and we are not talking abt alternative medicine but vitamins and supplements.

    I think docs are in a better position to advise patients but sad to say, most docs prefer not to answer such questions.

    Hope to see more of such docs who really care and are more involved in their patient's well-being and interest.

    By Anonymous Anonymous, At May 27, 2006 5:12 pm  

  • "Hope to see more of such docs who really care and are more involved in their patient's well-being and interest."

    I am also happy to see that more patients are interested in their own well being and interests and are asking questions and eager to listen.

    However the truth is that the large majority of people in Singapore are ignorant and uninterested in health matters and do not want to have any responsibility as far as their own health is concerned.

    Ask GPs and they will probably tell you most patients will say "I no study, catch no ball, dun understand, why u dogtor tok so much for what? Just gimme medicine and MC can liao lah"

    For every 1 person who is interested and asks questions and wants to get involved, there are about 10 other people who are totally "BO CHUP" about their health, medicine and personal roles and responsibilities.

    The fact is most of the GPs out there are playing to the majority of the market. And it makes sense don't you think?

    By Blogger Dr Oz bloke, At May 29, 2006 10:56 am  

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