ALTERNATIVE V. SCIENTIFIC MEDICINE COMMENTARY
Here are some interesting and thoughtful commentaries on my Op-Ed piece in
the Toronto Globe and Mail:

Michael: Good to hear that your attitude toward alternative medicine has
become less one-dimensional. I'm a medical practitioner straddling both
worlds and attempting to treat patients in a fully collaborative way,
presenting them with the options together with the evidence pro & con.
It's always bothered me that skeptics seem to completely lack skepticism
about modern medicine. I think it's healthy to be skeptical of all
forms of medicine, not just the alternative type. Incidentally, the
term "traditional medicine" in my opinion should be reserved for systems
like the Chinese or AyurVedic that are much older than the Western
version; not that this makes them any better--just of a longer
tradition. I like to refer to ordinary Western medicine as
"conventional medicine."
---------------------------------
Thank you very much for the editorial. I have long believed that people
went to alternative practitioners because the alts were just nicer than regular
MD's. Since becoming a parent, this truth has been slammed in my face more than
once, and I at least have a normal, healthy son.

When my son was about six months old, he contracted a persistent ear
infection. My pediatrician is wonderful, and carefully explained the need to watch his
fever, and to go the ER if it went above 103. On a Sunday, the fever spiked
to 103.2, and we rushed to the hospital, only to learn that everyone else in
Austin had done the same thing. Now, I know the placed was packed and the staff
hadn't slept in two days. Neither had we. It was more than an hour before we saw
the doctor, at which point he informed us that he wouldn't have brought the baby

in
for something like this, but that since we were there he would order some
tests.
This was bad, but in the next breath he told us that Andy's ears were clear,

so
the fever must be caused by something else, like meningitis. He then left.

We are both attorneys, and subscribers to Discover and Scientific American.

This
was about the worst thing he could have said, but to leave at that point
without
any further explanation was unforgivable. A clumsy phlebotomist drew blood,

and
a thug in scrubs (tattoos, odd piercings, and aparently incapable of speech)

took
a chest X ray. The only treatment Andy got was a large dose of infant
Motrin.
Four hours and $50 later (at least we have good insurance) we learned: he
had
an
ear infection. The doctor just didn't look far enough.

If this is the experience meted out to upper middle class educated people
who
can
easily sue, imagine what the poor, those who don't speak English, or those
lacking graduate degrees in argument experience. The situation requires
action.
I just wish I knew what to recommend.
---------------------------
Since my dog died I have often remarked that all of the vets and student
vets that I came in contact with during that sad few days were more
compassionate, more human and more helpful than any MD I have been in
contact with in my 50 years. When I talk to an MD they stare at me with
a blank face- no an incredulous face - like they don't believe a thing
that I am saying to them. - It is me ! - I'm the one with the concern -
my body! - but unless it is visibly bleeding they are so detached so-
well skeptical. At least that is how they make me feel - so - like so
many I don't go to them very often. ( I also do not go to the
alternative folk ) On the other hand the vets treated me with respect
and care as they treated the dog.
I chalk it up to the thought that the MDs are thinking , flipping
through their medical texts in their head as I am telling them how I
feel. ( But then I remember that 50% of them graduated in the bottom
half of their class).
------------------
Today there are many more researchers/scientists living than ever before in
history. Available free time which was virtually non-existant in the past
has
made it possible for innovative types to think, invent and discover.
Remember
in the past when only folks like Gregor Mendel had the free time because of
being provided for by the church? Now anyone in the developed world who
really
wants to can do research of one sort or another.

Naturally, this is resulting in a flood of new ideas and discoveries. The
scientific establishment cannot hope to keep up with it. Just look at the
numbers of papers being published. Any MD hasn't a prayer of being able to
keep
up with it. Even in his own narrow field, it is nearly impossible if he
also
wants to actually treat patients instead of do research. Any Medline search
will demonstrate this. Most doctors try to keep up the appearance of
omnicience, but the illusion is wearing thin. They no longer have the
God-like
mantle of omnicience or omnibenevolence. Furthermore, the HMO etc. system
has,
as you rightly noted, turned many into insensitive cogs.

Out of that flood of newly innovated material some things are right, and
some
worng, and some partly both. People know that some of it is real, and not
being
trained in scientific methods, turn to their own common sense and personal
scientific knowledge to sort it out. They also use anecdotal evidence from
friends, magazine articles etc. Modern medicine (alternative medicine) is
not
going through the narrow medical establishment channels because those
channels
are overwhelmed.

I think that the rise of alternative medicine is an unavoidable consequence
of
the large number of free thinking researchers alive today. As long as the
medical establishment remains a narrow conduit for approval of real new
medical
technology they will be bypassed by much of the public. Add to that the
"not
invented here" syndrome and you have an establishment that is rapidly making
itself increasingly irrelevant to people.
---------------------------
While realize that it is a generalization, I consider doctors to be at best
arrogant and at worst, suffering from a God complex.
Recently my wife and I decided to switch to a new doctor since we were no
longer comfortable with our current doctor.
We found it difficult, since any perspective doctor we chose, refused us as
soon they discovered that we already had a doctor in the city. If we had
moved from another city or our doctor had ceased to practice, they would
have gladly accepted our family. Eventually, we were told that doctors did
not take kindly to "doctor shopping".
The idea that we as patients don't have the ability or the right to choose
who we see as a doctor is indicative of the attitude they have. Do they
believe that we as patients are not intelligent enough to determine whether
or not a doctor is competent?
Even if this were the case, I am certainly capable of deciding what is
good for me and what I am comfortable with.
It's a pretty far stretch, even for a doctor, to think that he knows what I
want better than I do.
Who cares if I was "doctor shopping"? Any other profession would gladly
accept new clients, without question.
And while doctors may be intelligent, I am sure that the more arrogant one
is, the less wisdom he possesses.
------------------------------
I felt the need to respond to just one aspect of your article regarding the
lack of information and communication that was forthcoming from your
mother's
doctors.

Last year my brother was diagnosed with cancer. He took immediately to the
Internet and began researching the subject and exploring the various
hospital
web sites, support groups on-line etc. We were all amazed by the responses
he received. Many from doctors themselves. In fact, he received actual
phone calls from doctors located across the coast to offer him advice.

My brother is not a doctor or anyone "special" other than a working guy who
had received cancer diagnosis. The outpouring of helpful information was
truly incredible. Perhaps this source of information would have been useful

to you and your family. The use of the Internet should be a source others
should not forget exists today.
---------------------------------
I am not sure where the best place to reply or comment is - so I'll try this

and you can let me know of a preferred forum.

In the article attached I think Mr. Shermer puts a finger on a major failing

in modern medicine - the disassociation of doctors from their patients.

However, I also think he mentioned the primary cause of the problem without

focusing on it. The Doctor only spends about 8 minutes per patient. With

so little time there is also little opportunity for making a personal

connection or in depth discussion or even 'humaness'. Do doctors want it

this way? Not likely. It is this way due to economics. The cost of

delivering the care plus a profit for the Doctor vs what insurance and

people are willing/able to pay for that care boils down to 8 minutes a

patient. Just look at a physician's overhead in staff, equipment, insurance

(a biggie), education etc and the nature of the beast will be revealed. In

order to restore a doctor - patient dialogue and relationship, more time per

patient is required and the underlying economic pressures will have to be

addressed and solved before that can happen. Politics in the US faces a

similar dilemma - we bemoan the influence of big money on our 'leaders', but

put up with a system that requires politicians to raise huge sums of money

to be successful.
------------------------------
I would like to react on your article on ALTERNATIVE V. SCIENTIFIC
MEDICINE, where I can fully endorse your praise of what you call 'tender,
loving care'. But first off I would like to comment on the scientific
part of medicine, where it is important to differentiate between
scientific research and economic research. In my perception the latter
seems overwhelmingly more common. And so there are lots of drugs
available and tested (demanding lots of public money) which were never
even meant to attribute to general health, but only to provide a stream
of money into the pockets of shareholders.

An example of this: years ago I organized very small scale a regular
provision of medical drugs to Uganda in Africa, at that time a country
riddled with violence and chaos. Here I based my choices and estimations
(besides my own observations in 'the field') on the guidelines of the
World Health Organization, that stated the possibility to cure around 95%
of all diseases with about 100 different basic prescriptions. In this way
I was able to provide a lot of real help (often really making the
difference between life and death) for an unbelievable small amount of
money.

The state of affairs at the moment and predictable more so in the future
is that (even for all the might and power of modern medicine, I won't
deny that) the moment you step inside a hospital your lifespan is
decreasing. In part because there you'll find the most dangerous bacteria
and circumstances imaginable, but also because you are cut off from a
precious power of healing: yourself as a complete being that is striving
to balance even under extreme conditions. And it is your Loving Care that
is able to bring that back and nurture it (along with well chosen drugs
and other medical interferences).

In the meantime people are bedded in expensive hospitals at staggering
costs, while they should be better of in some sort of hotel at one third
of that dayprice with all the care they want, much better food and a much
greater sense of well being. People sense this and become increasingly
wary of the medical machine and in the process are in danger of becoming
the victim of an other machinelike something: the world of alternative
medicine and quacks and other charlatans. But this at least has some sort
of a friendly face and isn't dressed in chilly white smocks.

My anger, based on the sad and sometimes dreadful treatment of my old
parents, is especially directed at the fact that in contrast to all that
knowledge there seems so precariously little wisdom around. It doesn't
cost anything to hold the hand of someone dying, nor do you need a long
study. I get angry again at the thought of the day my farther died in
hospital - at his own request (and thanks to the fact that this is a
possibility here in Holland). His last day on earth - the most precious
day for him and his family. Early in the morning I found him, naked, half
washed and abandoned by a nitwit of a nurse who just had walked away to
talk to someone.

But another nurse, who really cared for him was not even informed of his
death - I had to tell her afterwards and had to comfort her. The good
thing was that we could all be together and I indeed could hold his hand
while he died. Still death has an ugly face even if it means a welcomed
liberation from pain and humiliation. So it has to happen within your own
realm, not as part of a mechanical system where your own sense of
belonging and responsibility is so easily overruled. I think here lies
part of the attraction of (the promises of) alternative medicine.

There is much more to be said about this subject (as about al the
promising medical drugs that are just not researched because it can't be
patented). Together with all the nonsense of alternative medicine it
seems to me you also have to expose the nonsense of much of the so called
scientific medicine. Just digging under the surface will reveal much dirt
that's completely unscientific. Just like organized religion, organized
medicine (of any kind) has a lot to do with raw power and oppression,
economic as well as mental...
----------------------------
You are absolutely right. This has actually been pointed out for many
years in those areas of the medical community that are interested in
these things (eg. family medicine). Alternative practitioners
flourish because they offer warmth, support, a listening ear, and
humanity, despite the fact that in some (many?) cases their
treatments are useless.

I agree with you 100%.

As a family doctor (although I am 46, I have only been in practice
for 2 years - I was a psychologist before then, which maybe colours
my outlook just a little!!) I think we should be "giving away" our
knowledge as much as possible, and we _must_ explain things and
educate our patients.

I'm also not above giving patients "useless" treatments if it makes
them feel better or suffer less - after all, we are supposed to be in
the business of relieving suffering. If a patient is worrying himself
sleepless over something, and insists on (say) an X-ray for which
there is no rational medical reason, rather than fight over the X-ray
as a waste of money, I'll tell him I'm happy to order it, but my
reason for ordering it is to relieve his fear and anxiety, not to
check up on his chest or whatever.

However, the system militates against that - doctors are paid much
better for _doing_ things rather than for thinking or talking. I'm
paid more for washing wax out of an ear, freezing a wart, or any
other simple or even trivial procedure, than I am for spending 15 or
20 minutes listening to, talking to, or educating a patient. And
unlike attorneys, it is unacceptable to the public for us to bill for
phone calls, doing research, or anything else other than getting
bodies in and out of the door.

It is a sad state of affairs when we are thinking about the bottom
line all the time, but in a capitalist society which treats medical
care as a commodity like any other, and pays for it like any other
kind of piecework, that's what you get.

Off my soapbox. But you are absolutely right. I only wish the flight
to alternative medicine didn't involve throwing the baby out with the
bathwater.
--------------------------------------------
An excellent article. In my experience you're absolutely right. And
nothing has changed. When I was in college in the 1950's I heard a
talk by Morris Fishbein, M.D., of the AMA about quacks as they were
then called. He said that quacks proliferated because physicians
could actually help the patient and so didn't bother to communicate
with them while quacks had nothing to offer and so were much better
salesmen and communicators.

Physicians concentrated on curing diseases, i.e., what the objective
symptoms showed, while quacks concentrated on curing the illness,
i.e. what the patient experienced. During the next fifty years this
insight has helped me obtain better care from physicians by stating
the illnesses I've experienced in the terms of disease. It's too bad
most physicians can't communicate with their patients but they are
still not trained to do so.

Ph.D's should not be hesitant to call themselves Dr. since they are,
or should be, scholars and learned persons which is the original and
still the first definition of the term. It wasn't until the 18th
century that physicians styled themselves Dr. and tried to have
exclusive use of the term.
----------------------------
1) I work at the student health service of the University of Minnesota. Of
necessity, when our patients need hospital admission we use the University
hospital across the street. An added complication is that a college-age
young
adult being admitted to a hospital is most often doing so for the first
time,
and has no idea what to expect of the experience. Teaching hospitals do tend

to
offer the most up-to-date, technically savvy care. But the other side of the

coin is that there is a much larger team acting as the patient's
physician--it's
less personal.

My experience is that the team members communicate well with each other,
outside
the patient's room, but communication with the patient is scant. A bunch of
things contribute to this: overworked med students and residents, the
assumption
that somebody else will talk with the patient, the scattering of visits and
decisions over multiple times through the day instead of one predictable,
dedicated visit as is traditional, etc.

Most of my admitted patients are for surgery--appendicitis, gall bladder,
complicated orthopedics (as they discover that they are not as unbreakable
as
they like to think), and so forth. Therefore, my involvement in their care
is
peripheral, the surgeons' central. Before I caught on to what my patients
were
experiencing, I made cursory social visits, but that was about it. Gradually

I
discovered the extent to which the patients were being left in the dark:
suddenly taken down for another CT scan without anybody telling them in
advance
or explaining why; blood drawn without explanation and with no later
reporting
of the results; transfers to a different room without explanation; one
medication being stopped and another started without notice, etc.

So I've wised up. Now, unless it's a dire emergency, I give my patients a
preview of what to expect, tell them how not to be daunted by the
ever-changing
roster of caregivers, the need to be assertive about getting explanations
and
being involved in decisions, etc. I give them my always-on cell phone
number
with no-shit permission to call me anytime if they're scared, confused, not
being taken good care of, uninformed, not getting sufficient pain relief,
etc.

What has amazed me is the therapeutic effect this little talk has, all by
itself. I rarely get called, but when I visit and check to be sure they
still
have my card with the number, it's almost always immediately at hand, sort
of
like a talisman. The relief of their anxiety is dramatic and palpable--they
react as if I've thrown them a lifeline. And after their hospitalization
they
tend to refuse to see any of my partners, requesting me by name, even for
unrelated issues. No other 5-minute period I spend with a patient has the
anti-anxiety and bonding effect that this does. It's immensely rewarding.

2) Coming out of medical school and residency, I was a dolt. That is, I was

well-trained, but I had very little clue about dealing with a patient on an
emotional level. Part of this is unavoidable--the learning curve is so steep

the
first couple of years out of residency that it takes all of one's
concentration
to analyze the patient's information and come to a diagnosis and treatment
plan.
The other part was my baseline personality: I'm so left-brained that I think

you
could shoot a bullet through the right side of my cerebrum and not hit
anything.
(Yeah, I know the old left-brain/right-brain thing isn't literal. But you
know
what I mean.) Despite many, many teachers imploring me to do otherwise, I
saw
the patient simply as a clinical problem to be solved as efficiently as
possible. I was raised in a family of scientists, where emotions were
treated
roughly as they would be on the planet Vulcan. And in retrospect I cringe to

think how plainly that showed. (Secret confession: I actually lost my first
job
because I had so many complaints from patients about how abrupt and uncaring

I
was.)

Suffice it to say that with hard work, I've changed. I haven't had a
complaint
like those old ones in years, and the most common compliment I hear, either
directly or through other staff with whom the patients discuss me, is that
they've never had a physician listen and make them feel so *personally*
cared
for.

I don't say that to boast, but to say that (A) such transformations are
possible, but (B) they are enormously difficult for the kind of person who
typically applies to medical school. If I hadn't had the near meltdown of my

career from being fired for lack of compassion, I doubt I ever would have
reformed myself.

3) I don't know to what degree you're aware of the appalling *lack* of
scientism
among clinicians. It's well-documented and would probably shock you if you
haen't been faced with the evidence before. Doctors habitually elevate their

own
anecdotal experience over evidence from controlled trials; they persist in
old
prescribing patterns years after treatments are proven ineffective; they
routinely seek to confirm a clinical hunch rather than trying to disprove it

(thus missing alternative diagnoses); they rely more on drug manufacturers'
sales representative and advertising than on objective analyses of a
medication's effects; they engage (behind the scenes) in more magical
thinking
than you would imagine; they are not just subject to the availability
heuristic,
they're pretty much slaves to it. In short, you might be willing to excuse
incompassionate personality in your doctor if in exchange you could be
assured
of a rigorously rational and scientific approach to your problem--but you
usually don't get it.

I've long toyed with the idea of writing an essay about this for Skeptic,
something like "Is Your Doctor a Skeptic?" Interested?

If I've kept your attention this long, I thank you for it--and for all the
great
stuff you write in my favorite magazine.
---------------------
Doctors and Nurses are bound by confidentiality requirements. They can
lose their licenses or commit a criminal offense by improper disclosure
of information.

In medicine, you never break a law by not telling. You can easily break a
law by telling something to the wrong person.

As the husband of a frequently hospitalized wife, I believe the legal
structure contributes a lot to the situation.
-------------------
I just wanted to clarify some misinformation you printed in the article
by Michael Shermer on Alternative Health Care and TLC.
Some alternative practitioners are well trained. I am currently
enrolled to complete my DOCTORATE of naturopathic medicine at the
Canadian College of Naturopathic Medicine (www.ccnm.edu). I am
becoming medically trained through courses in anatomy, histology,
physiology, biochemistry, pharmacology, microbiology, obstetrics and
gynecology, etc. I take offense in that article. Could you please
advise Mr. Shermer to RESEARCH his topics before writing articles! I
don't care if he believes in alternative health care, but get the facts
right at least. As well, there is plenty of research on several
medicinal herbs in "traditional medical" journals such as JAMA and the
New England Journal of Medicine if Michael cared to look.
---------------
This "doubling of life span" you so often attribute to modern medicine
is first-off a bit of statistical sleight-of-hand. It is true that life
spans have increased in the past century, but this is due mostly to
lower infant mortality rates. After all, the Bible, which you cited
earlier puts our life span at "Threescore and ten" the most skeptical
among us might assert that this is not an ancient life span, but one
from the time of the writing of the King James Bible. Correcting for
the volatile infant mortality rate as economists correct for the
volatile food and energy sectors of the economy, it looks like our life
span has increased bloody little.
Second, the increase in life span is due at least as much to public
health practices as to our heroes of modern scientific medicine, and
most public health personnel don't pull down $300k a year either.
Since you seem to be interested in an unvarnished account of the
physical world, may I suggest you cease the gee-whiz, pro-science "spin".