BC Naturopaths imminent to have power to prescribe/order labs/image/minor surgery

[apache]

I'm actually pretty pro-allopathic, but it's important to keep an open mind and remember that as a physician you are a healer, not just a practising pharmacologist, and that there are many ways of healing. The only reason I'm even defending naturopathic medicine is because I know all of the stuff that works in psychiatry and that should be given a legitimate shot (my friends trichotillomania spontaneously remitted after dosing on NAC by a prudent psychiatrist), I'd been telling her about it forever, but she was the type that didn't believe in any kind of medication, natural or pharmaceutical, but it's totally improved her quality of life.

 

I guess what I'm saying is that as a physician you have to try and be open minded to all reasonable possibilities, I've met so many doctors that are dismissive of taking vitamins for health simply out of emotional reaction. You can buy the compound isolated in red wine (revesterol, i think?) which has been linked to it's benefits in cardiovascular disease in a pharmaceutical grade supplement or powder... and there's not doubt that while there's not studies on this, this would likely be of benefit, with no obvious harm to the patient, so why not give it a try?

 

I'm not trying to defend the snake oil guys who talk about diluting water and what not but trying to convince people to be open minded, because, some naturopathy (if you wan't to call it that, things like sam-e, nadh, phenylalanine, tyrosine, kava kava, n-acetyl cysteine, metabolized form of b vitamins (for better absorption), selenium, phytonutrients all have delineated specific benefits)... the problem is that patients are just going to these nutrition stores, buying this stuff up, without talking to their doctors about potential benefits and risks, i often find myself having to correct what people at nutrition stores tell their customers, and i find that a bit disturbing.... i guess to sum it up, i think perhaps a paradigm shift from general "acute medicine" to a more comprehensive preventative approach, which includes proper nutritional training should be incorporated into the md program, rather than having naturopaths who know about say st john's wort, but not know that an interaction with citalopram can cause serotonin syndrome, or may prescribe mucuna pruriens for energy, without realizing that it contains a lot of leva-dopa, which can be a dangerous thing if the person is on a stimulant for adhd... same with giving kava kava out... have you done a liver panel... doubt it

 

i think it's time physicians stepped up and provided all encompassing health care, because this divisiveness is dangerous... at least imo

 

I'd just like to see qualified MD's become more knowledgable about this kind of stuff

 

Allopathic medicine is providing the best treatments and managements for patients according to the evidence that exists in the literature. If pixie dust is proved in a randomized control trial to be effective for any disease, then you can bet it will be instituted as soon as possible. It isn't about drugs vs natural remedies, it's about delivering the best treatments to patients.

 

There can be no other philosophy of medicine other than the aforementioned.

[apache]

i think that would be a great route for people to really feel out medicine and it's practice and truly find what they want after a few years of practice... it would also be far less limiting, i'm sure there are a lot of frcpc emerg docs who would love to do some family practice blended in with emerg, but can't because they aren't licensed too

 

I agree we could solve many of the primary care problems by going back to the old general lisence system, instead of the family med 2 year program we have right now.

[Wayward son]

You can buy the compound isolated in red wine (revesterol, i think?) which has been linked to it's benefits in cardiovascular disease in a pharmaceutical grade supplement or powder... and there's not doubt that while there's not studies on this, this would likely be of benefit, with no obvious harm to the patient, so why not give it a try?

 

But with no studies then you simply can not say what the harm may be. In red wine reversterol is ingested in combination with other compounds that may enhance or diminish any benefit or harm. When isolated maybe any side effects are minor. Maybe they are not. Maybe there are significant side effects for people with certain conditions. And at what dose? Maybe it is beneficial at a certain dose and but causes significant side effects at a higher dose. Of course, they are free to spend their money however they wish, but I will not suggest that they might as well try something because why not? If they asked me I would have no problem telling them why certain people think that it may work, and that due to a lack of study there is no way to know what the risks, if any, are.

 

Why would a doctor recommend a patient take something that they have idea if it works, what conditions it is beneficial for, who should not get it based on other conditions, how it works, what side effects it may have and so on? That is experimentation - and experimentation without controls or a trial to document the results. I am not asking for extraordinary evidence here.

 

My grandmother was given a dozen different treatments over the course of a year to correct a condition for which the alternative practitioner didn't have even the most basic understanding of at the end of that year. When I had it out with him he responded that each of them could have helped and was unlikely to do any harm. Says who? Yes, it is possible that he could have completely by accident recommended something that worked - but he sure wasn't expressing that extreme unlikelihood of benefit to her. And it is easy for him to say that these untested treatments are unlikely to cause harm - he doesn't have to live with the consequences if they do. And even if they themselves have no obvious side effects, there is also the side effect of the patient being lied too, given false hope, and directing money towards nonsense that left her eating cheaper food and almost no fruits and vegetables.

 

I'd just like to see qualified MD's become more knowledgable about this kind of stuff

 

We definitely agree on this. However we have a different opinion on which way things will go if they become more knowledgeable. You appear, at least to me, to believe that they will move from being more cynical to more accepting of the usefulness of many of these treatments. You may be right. I believe that if they become more knowledgeable about CAM they go from being largely unaware of the evidence either way (shruggies as Dr. Steven Novella refers to them) to opponents when they realize that alternative medicine is mostly built on a combination of extremely bad science mixed with extremely poor evidence. I will except any alternative medicine that has legitimate evidence, but considering that the National Center for Complementary and Alternative Medicine (NCCAM) has spent over a billion dollars testing many of these treatments without coming up with positive results, and considering that Edzard Ernst, prof of complementary medicine and former homeopath, states that 95% of alternative medicine either lacks evidence, or has evidence of showing a lack of efficacy - along with often also being based on a biologically implausible claim - I don't expect to be overwhelmed with candidates.

 

Mainstream medicine is flawed. The evidence for much of it is not strong enough and is too strongly influenced by drug companies and their drive for profit often at the expense of accurate information about their results. I wish their were stronger efforts to deal with those flaws. But I don't see any benefit resulting from looking at the problems with mainstream medicine and concluding that one way to improve it is integrate alternative medicine which has even greater flaws, worse methods, poorer evidence, continued promotion of implausible treatments, the same drive for profits at all costs. Seems like the worst of both worlds to me.

[apache]

i think we mostly agree, i may come off as a little extreme in defence of naturopathy (i think most of it is crap, actually) because i've encountered many people who so fervently believe in the evidence based medicine paradigm without looking into the influence of financial and other interests... i don't have to go on, you know what i'm talking about. my philosophy is just to keep an open mind... if ketamine rapidly cures treatment resistant depression lets screw all the moral questions and administer it safely, i know a few people who're depressed and use ketamine because it makes it feel good for a couple weeks after... maybe we should try having a doctor administer the stuff safely and in a supervised manner so people don't have to self medicate etc.

 

with regard to revesterol or anything like that studies should be conducted, but unfortunately you and i both know that things which won't make money don't get funded. that's why we don't see tianeptine (a selective serotonin reuptake enhancer) used in north america... it's been used in europe for 40 years, it's patent is expired, it has virtually no side effects and is very light on the liver and kidneys yet the fda demands they run clinical trials to show superiority over an ssri (the lack of side effects or withdrawal effects is a good start)... is servier really going to spend billions of dollars on a drug that's lost it's patent...

 

But with no studies then you simply can not say what the harm may be. In red wine reversterol is ingested in combination with other compounds that may enhance or diminish any benefit or harm. When isolated maybe any side effects are minor. Maybe they are not. Maybe there are significant side effects for people with certain conditions. And at what dose? Maybe it is beneficial at a certain dose and but causes significant side effects at a higher dose. Of course, they are free to spend their money however they wish, but I will not suggest that they might as well try something because why not? If they asked me I would have no problem telling them why certain people think that it may work, and that due to a lack of study there is no way to know what the risks, if any, are.

 

Why would a doctor recommend a patient take something that they have idea if it works, what conditions it is beneficial for, who should not get it based on other conditions, how it works, what side effects it may have and so on? That is experimentation - and experimentation without controls or a trial to document the results. I am not asking for extraordinary evidence here.

 

My grandmother was given a dozen different treatments over the course of a year to correct a condition for which the alternative practitioner didn't have even the most basic understanding of at the end of that year. When I had it out with him he responded that each of them could have helped and was unlikely to do any harm. Says who? Yes, it is possible that he could have completely by accident recommended something that worked - but he sure wasn't expressing that extreme unlikelihood of benefit to her. And it is easy for him to say that these untested treatments are unlikely to cause harm - he doesn't have to live with the consequences if they do. And even if they themselves have no obvious side effects, there is also the side effect of the patient being lied too, given false hope, and directing money towards nonsense that left her eating cheaper food and almost no fruits and vegetables.

 

 

 

We definitely agree on this. However we have a different opinion on which way things will go if they become more knowledgeable. You appear, at least to me, to believe that they will move from being more cynical to more accepting of the usefulness of many of these treatments. You may be right. I believe that if they become more knowledgeable about CAM they go from being largely unaware of the evidence either way (shruggies as Dr. Steven Novella refers to them) to opponents when they realize that alternative medicine is mostly built on a combination of extremely bad science mixed with extremely poor evidence. I will except any alternative medicine that has legitimate evidence, but considering that the National Center for Complementary and Alternative Medicine (NCCAM) has spent over a billion dollars testing many of these treatments without coming up with positive results, and considering that Edzard Ernst, prof of complementary medicine and former homeopath, states that 95% of alternative medicine either lacks evidence, or has evidence of showing a lack of efficacy - along with often also being based on a biologically implausible claim - I don't expect to be overwhelmed with candidates.

 

Mainstream medicine is flawed. The evidence for much of it is not strong enough and is too strongly influenced by drug companies and their drive for profit often at the expense of accurate information about their results. I wish their were stronger efforts to deal with those flaws. But I don't see any benefit resulting from looking at the problems with mainstream medicine and concluding that one way to improve it is integrate alternative medicine which has even greater flaws, worse methods, poorer evidence, continued promotion of implausible treatments, the same drive for profits at all costs. Seems like the worst of both worlds to me.

[apache]

Fair enough, I agree with you, and evidence based medicine, it's just the politics and money of evidence based medicine that has me worried.

 

Reboxatine, Tianeptine are good examples of effective anti-depressents that aren't used in North American hospitals because of financial interest.

 

You quoted me, and based on your point I think you are replying to my absoluteness.

 

I am trying to say that if in naturopathic medicine, there is something that is shown to be effective, then it would be administered in allopathic medicine. The only reason a certain drug isn't administered is because according to evidence based practice there is no evidence for it.

 

The only way to practice medicine is to give the best possible management to your patient. This is what allopathic medicine strives to do, regardless of whether the management is giving pharmaceutical drugs, a plant, etc. I'm not against NDs, I'm just pro-evidence based practice.

[Wayward son]

i think we mostly agree, i may come off as a little extreme in defence of naturopathy (i think most of it is crap, actually)

 

Yes we agree for the most part, and I understand your position is not extremely supportive of naturopathy - my response was towards you, but mostly geared to others who have less of an understanding of the problems with some alternative medicines.

 

with regard to revesterol or anything like that studies should be conducted, but unfortunately you and i both know that things which won't make money don't get funded.

 

I mostly agree - although NCCAM does fund studies, as do some universities. Which leads to two issues for me. 1) Should all studies be funded publicly? This would cost money, but at the same time should (at least in my mind) dramatically lower the cost of drugs (would that even out? Maybe even save money? I have no idea). It would also allow a far greater likelihood that some therapies would be funded that otherwise would not. I say yes they should be - but I am certainly no expert and can't properly weigh the pros and cons (not that it will ever happen anyways). 2) Does studying alternative medicines even matter? The NCCAM has done studies that have shown certain alternative medicines do not work at all. This has had zero impact on those who manufacture, sell and consume those Alt Med products. So if the sellers of the products don't care that their products don't work, and the consumers don't care either...then why spend the money to provide the evidence when neither group has any interest in what the evidence says? I still care, and hope that at least some consumers choose other products instead.

[Wayward son]

Hey guys, mind if I jump in for a sec?

 

This was pretty much inevitable. Demend for healthcare keep going up, but the supply of tax money doesn't. The quality of healthcare in this country has to go down SOMEHOW.

 

It's kind of like newton's laws.

 

F = m * a

 

Now pretend that F = healthcare spending, m = demand for healthcare, a = quality of healthcare. If the demand (m) goes up, the quality (a) MUST go down.

 

I think this was a really dumb way of reducing costs, because now many uninformed people will visit these "doctors" and die (or worse).

 

It is not that simple. There are ways of delivering better health care for less, just as there are ways of delivering worse health care for more. The US, for instance, has done a good job at the latter.

[aaronjw]

Yeah sounds great in theory but reality is more complicated.

 

I believe there is a better way to handle healthcare in this country but its going to require a politician with some balls who actually cares more about doing right for people as a whole over special interest groups or keeping their jobs. Sometimes the right choice isnt always the popular one.

 

As a side note, what could be worse than dying?

 

 

Hey guys, mind if I jump in for a sec?

 

This was pretty much inevitable. Demend for healthcare keep going up, but the supply of tax money doesn't. The quality of healthcare in this country has to go down SOMEHOW.

 

It's kind of like newton's laws.

 

F = m * a

 

Now pretend that F = healthcare spending, m = demand for healthcare, a = quality of healthcare. If the demand (m) goes up, the quality (a) MUST go down.

 

I think this was a really dumb way of reducing costs, because now many uninformed people will visit these "doctors" and die (or worse).

[vanillabear]

Kinda off topic... but what do you guys think of CP24 pretty much promoting "alternative health" like Homeopathy with that Wylde on Health guy?

[Wayward son]

Kinda off topic... but what do you guys think of CP24 pretty much promoting "alternative health" like Homeopathy with that Wylde on Health guy?

 

I don't know if it has improved in the last year, but if not, it is basically an infomercial for homeopathy and Wylde's other business interests. I have boycotted the station since I first watched him. This is person who in his first book (which was published a year before his cp24 tenure started) advocated eating broccoli in place of the HPV vaccine. Any station so unethical as to allow this kind of extreme quackery to be foisted upon their viewing audience should not be watched by sensible people.

[cliff_merchant]

I had minor surgical procedure three days ago to repair a droopy eyelid & have been walking a low grade temperature every afternoon & evening since. I wake up & its normal but by 12:00 it is back. It does reply a tiny bit to tylenol. I went to surgeon yesterday & they doesn't think it is related to the surgical procedure. I think it may be related. I think I have run tiny fevers historically after other surgeries. Does somebody know if his is common?

 

Regards,

Cliff merchant MD

[RyanMaverick]

I had minor surgical procedure three days ago to repair a droopy eyelid & have been walking a low grade temperature every afternoon & evening since. I wake up & its normal but by 12:00 it is back. It does reply a tiny bit to tylenol. I went to surgeon yesterday & they doesn't think it is related to the surgical procedure. I think it may be related. I think I have run tiny fevers historically after other surgeries. Does somebody know if his is common?

 

Regards,

Cliff merchant MD

 

I'd definitely go see a naturopath. A droopy eyelid can only be appropriately treated with all-natural treatments. The eye-droop is clearly a sign of over-accumulation of toxins from synthetic drugs and foods in the eyelid tissue causing said droop. You could also really benefit from a "body cleanse".

[RiceWine]

I had minor surgical procedure three days ago to repair a droopy eyelid & have been walking a low grade temperature every afternoon & evening since. I wake up & its normal but by 12:00 it is back. It does reply a tiny bit to tylenol. I went to surgeon yesterday & they doesn't think it is related to the surgical procedure. I think it may be related. I think I have run tiny fevers historically after other surgeries. Does somebody know if his is common?

 

Regards,

Cliff merchant MD

 

where did u do your MD again? we "dosen't" know