Why people choose alternative medicine

[Dr.Cave]

I'm in my family med rotation in clerkship and have come accross quite a number of patients who have quit there traditional drugs for "natural treatments." I have to do a small project in this rotation and I think this is an interesting topic. Some of the questions I'd like to look at:

 

1) Why do some patients mistrust good science but love pseudoscience?

1a) what methods does pseudoscience use to foster this attitude?

 

2) What myths do the alternative medicine practioners/followers believe about evidence based medicine?

 

3) Why do people, even those highly educated in science, place so much faith in the single data point (testimonial, case report) vs our best understanding of reality (well designed, unbiased, repeated and verified scientific study)?

 

4) Which alternative medicine practices have good evidence to show they work?

 

5) Which alternative medicine practices have good evidence to show they don't work and which of these are still covered services in different provinces.

 

6) What can doctors do to prevent patient harm from charlatanism?

 

7) what can doctors do to change attitudes of patients who distrust science?

 

 

 

 

Let er rip.......

[Dr.Cave]

Myth #1 Seen in many naturpath websites including the Boucher Institute's (one of Canada's Certified schools

 

Naturopathic medicine, also known as naturopathy or natural medicine, is practiced in many countries, especially Canada and the United States.

Melissa says the basis of naturopathic medicine is to target the root cause of an illness and promote healing using natural therapies.

“So rather than simply treating or suppressing symptoms, the primary goal is to address the cause of the illness,” she explains.

 

Myth #2 Doctors are in the pocket of Big Pharma

 

Reality, big Pharma tries to influence docs but professional colleges set strict guidelines. In fact it is much more blatantly obvious that Naturopaths are in the pockets of "Big Herbal". Did you know that the Boucher Institute (Certified BC ND School) actually sells access to its students? Here's an excerpt from their website with a link. Absolutely shameless.

-------------------

BINM is committed to building strong relationships with companies and other institutions interested in establishing ties with the Institute. BINM identifies three main categories for partnering:

 

1. Commercial companies interested in accessing naturopathic medical students to share information on their services and products. Companies can engage in two possible campaigns:

 

• Partnering with BINM

• Facilities naming opportunities

 

http://www.binm.org/docs/opportunities.pdf

[Jochi1543]

Without writing a novel, some things that came to mind:

 

1) Why do some patients mistrust good science but love pseudoscience?

1a) what methods does pseudoscience use to foster this attitude?

 

I think there are several big reasons. One is the concern that "good science" is the product of money-hungry pharma companies and researchers who wouldn't have a job if they didn't have a couple of studies going (often financed by said pharma companies). This leads people to worry about the harmful effects of "modern" treatments that are glossed over in favor of $ (yes, ironic, I know). Second comes the desire to reconnect with your ethnic roots and spirituality and the desire to follow tradition. E.g. my grandmother is heavy into herbal medicine, and when I follow her advice (nothing intense, just things like wild strawberry tea, valerian root, and the like), I feel like I'm taking advantage of the knowledge previous generations have amassed. The third reason is simply that "good science" is beyond the educational level of many people. Hardly anyone outside of the field will go and check out an issue of the NEMJ and read scientific studies. At best, they will read the VERY watered-down version of it in a magazine, which may often provide incorrect info because the journalist is usually trained in writing, not in science. Last but not least, of course there's the "natural" and hippie aspect of things.

 

 

3) Why do people, even those highly educated in science, place so much faith in the single data point (testimonial, case report) vs our best understanding of reality (well designed, unbiased, repeated and verified scientific study)?

 

I think it's about relatability. If this-and-that worked for Uncle Bubba, that's gotta work for me, because we've got a lot in common! And things like testimonials (not talking about the ones in ads, but the ones people randomly volunteer to you) are generally made with other people's interest in mind. You wouldn't go and endorse something on every corner unless it worked for you. Therefore, people feel that they can trust something that's more personal and individualized.

[Dr.Cave]

Totally agree with the above.

 

 

3) Why do people, even those highly educated in science, place so much faith in the single data point (testimonial, case report) vs our best understanding of reality (well designed, unbiased, repeated and verified scientific study)?

 

I think another reason people put so much faith in testimonials is that our brains have evolved to make discrete decisions, we view cause and effect as all or none phenomena (Ugh fire burn. Thag no touch fire. Oooh. Woman soft. Thag touch woman). We don't readily see that much of reality comes in varying shades of gray. I guess thats what studying science is supposed to impart - reality is way more ****ing complicated than we usually consider it to be.

[AdamP]

reminded me of this article

 

http://www.cmaj.ca/cgi/content/full/179/1/108

 

it deals mostly with the types of news we like to hear, but it makes the case that humans have mostly evolved to remember stories rather than numbers.

 

So in the case of alternative med people are more attracted to the miracle story rather then standard deviations and r-squaredes....

[da_birdie]

Myth #2 Doctors are in the pocket of Big Pharma

 

Reality, big Pharma tries to influence docs but professional colleges set strict guidelines. In fact it is much more blatantly obvious that Naturopaths are in the pockets of "Big Herbal". Did you know that the Boucher Institute (Certified BC ND School) actually sells access to its students? Here's an excerpt from their website with a link. Absolutely shameless.

 

Check below:

 

Boucher Institute - Corporate Support and Sponsors

Visionary

$26,000 2001 Hecht Foundation

$40,000 2002 Hecht Foundation

$41,000 2003 Hecht Foundation

$90,000 2004 Hecht Foundation

$86,000 2005 Hecht Foundation

$41,000 2006 Hecht Foundation

Sponsor

$10,000 2003 Selecta

$10,500 2004 Thorne Research

$9,155 2006 Metagenics

$6,675 2006 Thorne Research Inc

$7,410 2007 Bill Robinson (Nicole Robinson Scholarship

Fund)

$18,000 2007 Hecht Foundation

$9,650 2008 Bill Robinson (Nicole Robinson Scholarship

Fund)

Supporter $5,000

2002 Purity Life

2002 Naturpharm Inc.

2003 Tzu Chi Institute

2004 Purity Life

2004 NaturePharm

2006 BioMed International

2006 Boiron

2007 Minerva Foundation

2007 Quinton America

2007 St. Frances Herb Farm

2008 St. Francis Herb Farm

2008 BioMed International

2008 Minerva Foundation

Friend $2,500

2002 Seroyal International Inc.

2002 Professional Health Products

2002 NCNM Library

2003 Professional Health Products

2003 Advanced Orthomolecular Research

2003 Wise Woman Herbals

2003 Moore Library

2003 Radar Computer Repetory

2003 Kent Computer Repetory

2004 York Downs Pharmacy

2004 Seroyal International Inc.

2005 York Downs Pharmacy

 

Source: Boucher Institute Academic Calendar (pg 37-41)

http://www.binm.org/docs/AcademicCalendar.pdf

 

[RobynM]

I think a lot of people have become disillusioned by traditional western medicine and are therefore looking for alternatives. I think that a lot of people that go to naturopaths don't completely stop going to MDs as well I think that people feel like they want to get as many opinions as possible and educate themselves. I think it's the fact that so many doctors basically tell the patient "trust me i'm a doctor" and the patient feels uninformed and less likely to trust the treatment. The average appointment with an MD lasts, what, 10 minutes, while the average naturopath appointment lasts more like an hour (with the initial assessment probably about 2 hours).

 

I think the more wholistic approach of naturopathic medicine is also appealing to a lot of people. The idea of trying to treat the root problem instead of the symptom seems like a better approach to me and I think as people hear horror stories about a person being on drug upon drug in order to treat symptoms, without actually treating the illness they start to look for alternatives.

 

I'm not necessarily saying that naturopathic medicine is better or even effective for everything. But I do think that it is the "assembly line" medicine that has been adopted due to doctor shortages, etc. that has led people to look for different approaches. I also think that completely dismissing the naturopathic approach doesn't help anything and just perpetuates the idea that MDs are arrogant and closed minded. Instead of just bashing the group as a whole wouldn't it be better to take a look at the good and bad things and try to work together, because like it or not patients will still look for alternatives and in order to best treat the patient we should be informed about these alternatives.

[Dr.Cave]

RobynM I see you have bought into one of the naturopaths myths - MDs only treat symptoms whereas naturopaths treat the source of the problem. While there are certainly many cases where MDs treat symptoms when possible we treat the root of the problem too. for example smoking cessation, anemia, neural tube defect prevention, hemophilia, too many to list really. See how easy it is to be deluded by the propaganda?

 

If you have vague treatments that really do nothing (homeopathy is a core of the ND curriculum) then you have to make claims to treat the underlying cause by balancing organs and opening energy flow - things that can;t be verified. If you claim to treat symptoms then people will actually have something objective to measure treatment success by. Don;t get me wrong, I think some Naturopathinc management is highly effective - diet, exercise, counselling and motivation, I just wish the field would stop the pseudoscience treatments and the misinformation about MDs.

[NLengr]

Don;t get me wrong, I think some Naturopathinc management is highly effective - diet, exercise, counselling and motivation, I just wish the field would stop the pseudoscience treatments and the misinformation about MDs.

 

But that would cut too deeply into profit margins.

 

If I hear the BS line of "MD's treat only symptoms, naturopaths treat the underlying problem" one more time, I'll probably lose it. What a load of BS. Even the general public should be able to figure that out.

[A-Stark]

Agreed. You'd think that Beta blockers, ACE inhibitors, and nitro patches treat high BP like a "symptom". I mean... WTF. The exact reason why anti-cancer drugs have such profound side effects is because of how they treat the "underlying" problem. The reason why similar naturopathic treatments have minimal or non-existent side effects is because they don't do anything. Or else they interfere with said anti-cancer drugs. (feel free to insert anti-retrovirals, statins, or psychoactive drugs there too)

[rla_z]

The majority of the people are ignorant. The same morons are the types of people rejecting vaccinations.

[Microbiodude]

Agreed. You'd think that Beta blockers, ACE inhibitors, and nitro patches treat high BP like a "symptom". I mean... WTF. The exact reason why anti-cancer drugs have such profound side effects is because of how they treat the "underlying" problem. The reason why similar naturopathic treatments have minimal or non-existent side effects is because they don't do anything. Or else they interfere with said anti-cancer drugs. (feel free to insert anti-retrovirals, statins, or psychoactive drugs there too)

 

I guess there's two different ways to interpret "underlying cause"

 

Is the Beta blocker treating your underlying cardiovascular disease (CD) or is it treating CD which is a symptom of body imbalances due to lack of physical activity and neglecting a healthy diet? (yes I know physicians play an active role in trying to help their patients modify their lifestyle). Though I will admit Homeopathic medicine is the most ridiculous thing I've heard...but at the same time a placebo can be a very effective form of treatment.

[A-Stark]

A placebo is not a treatment, nor is it "effective" in general. Sugar pills won't lower BP, though hypertension may resolve given other non-pharmacological factors (better diet, more activity). I'm not clear on what other "underlying cause" there is, as naturopathic and/or "alternative" types simply assert that that's what they treat. Sodium or calcium channels blockers will treat the causes of arrhythmias directly - what will a placebo do?

[Microbiodude]

I suppose placebos are more effective as treatment (i.e. you are treating the disorder with the placebo) in psychiatry than any other field.

 

http://www.guardian.co.uk/education/2002/jun/20/research.highereducation

 

http://www.pharmj.com/pdf/comment/pj_20041127_onlooker.pdf

 

http://cat.inist.fr/?aModele=afficheN&cpsidt=1789012

"Placebo : Efficacy and Adverse effects in controlled clinical trials" [WEIHRAUCH T. R. (1) ; GAULER T. C. (1) ;]

 

The underlying cause I was referring to was poor diet and inactivity. I know some naturopaths direct their patients to cut-back on processed foods/ fast foods during the course of their naturopathic "treatment." Inadvertedly, its the diet change that results in health improvements and due to confounding error patients associate it with the "medication."

[Tango Charlie]

The most common reason for trusting alternative medicine over actual medicine has been, in my experience, the myth of medical doctors being beholden to Big Pharma. It's an absurd myth which I am certain the alternative medicine industry has some hand in perpetuating, but whatever the cause, it is definitely effective. People believe that medicine is practiced with financial gain in mind, rather than patient outcome. Alternative medicine very nicely tries to fit the role of the down-to-earth, compassionate, people-savvy "doctors", rather than those stuffy nerds who just want to increase the stock value of Apotex.

 

I suppose the other part of it is that much of alternative medicine is side-effect (and effect, incidentally) free. That is, there's no perceived risk with most of it. No chance of something going awry and the patient winding up with an iatrogenic injury or illness. So, no doctors who are going to try to press treatments on you to put money in the pocket of Big Pharma, and no risk to yourself? Sounding pretty good so far, right?

 

Combine the two with the same healthy dose of ignorance that keeps people on the fence about things like evolution, and you have a recipe for pseudo-medicine. And if they're still battling "intelligent design" in the schools down in the USA, you can bet fixing this bizarre attitude will be virtually impossible to achieve.

[Carabiner]

I'm not necessarily saying that naturopathic medicine is better or even effective for everything. But I do think that it is the "assembly line" medicine that has been adopted due to doctor shortages, etc. that has led people to look for different approaches. I also think that completely dismissing the naturopathic approach doesn't help anything and just perpetuates the idea that MDs are arrogant and closed minded. Instead of just bashing the group as a whole wouldn't it be better to take a look at the good and bad things and try to work together, because like it or not patients will still look for alternatives and in order to best treat the patient we should be informed about these alternatives.

While I disagree with the rest of your post (I think doctors are making more of an effort to be "holistic"), I think you bring up the good point of doctor shortages. When a doctor devotes only 10 minutes with a patient in a clinic, it doesn't really leave the patient feeling reassured, and probably isn't likely to allow the doctor to give a "holistic" assessment of the patient. This patient's going to go elsewhere, possibly a naturopath, who can give more time to the patient.

 

If a doctor wants to do the best thing for his/her patient--like prevent the patient from going to some crockpot naturopath and getting useless treatments--all the doctor can do is devote more time and empathy to a patient.

[leviathan]

I think the more wholistic approach of naturopathic medicine is also appealing to a lot of people. The idea of trying to treat the root problem instead of the symptom seems like a better approach to me and I think as people hear horror stories about a person being on drug upon drug in order to treat symptoms, without actually treating the illness they start to look for alternatives.

Robyn,

 

Can you name me any conditions treated by naturopaths at the 'root cause' versus physicians only treating the symptoms? I am curious to know if you have actually heard of any examples, or if you just read that statement and accepted it as fact without verifying it.

[The_B]

The majority of the people are ignorant. The same morons are the types of people rejecting vaccinations.

 

I really really really don't like alternative medicines....

 

but that is an ignorant statement in my opinion. Many of these people aren't morons. They are desperate. If you were terminal with renal cell carcinoma, and the doctors said there was nothing more they could do for you, who wouldn't try a few herbs in their darkest hours.

 

or those people who have been mistreated by the medical system are naturally going to attach themselves to any alternative. Do we fault others for not being educated? In medicine, our job isn't to judge, but to educate people 1) why we don't use alternatives, and 2) to explain why we do use traditional stuff. It easy from our perch of education to dismiss alternatives for what they too often are, but it is another thing to expect a high school grad who never took anything past general level grade 10 science to understand that we use ACEi because of its proven effects on the whole angiotensin system vs using echinacea for a cold and why it likely won't work and how their is little evidence.

[leviathan]

I really really really don't like alternative medicines....

 

but that is an ignorant statement in my opinion. Many of these people aren't morons. They are desperate. If you were terminal with renal cell carcinoma, and the doctors said there was nothing more they could do for you, who wouldn't try a few herbs in their darkest hours.

Of course, but these people are in the minority. Most 'patients' of naturopaths and the like are normal people who choose that route for other reasons. Ignorance is usually a part of it.

[The_B]

Of course, but these people are in the minority. Most 'patients' of naturopaths and the like are normal people who choose that route for other reasons. Ignorance is usually a part of it.

 

What you call ignorance, I call a lack of education. Perhaps they may mean the same thing, but I think the connotation is very different. When you say ignorant, you are labeling these people in such a negative light when it really isn't their fault.

[A-Stark]

A lack of education in what respect? I have a friend who did a psych degree with bio and goes to a naturopath to treat her chronic fatigue and systemic candida.

[n00b]

why see an alternative med and pay out of pocket when you can go to MDs for free?

[Jochi1543]

why see an alternative med and pay out of pocket when you can go to MDs for free?

 

A great question. Maybe some benefit plans cover alternative treatments? My work benefits partially cover the more widely accepted alternative care, such as massage and chiro, but I'm not so sure about accupuncture and herbal meds...

 

EDIT: just read through it, it doesn't cover naturopaths.

[n00b]

i see no benefit, financially or scientifically, in going to alternative

[Microbiodude]

A lack of education in what respect? I have a friend who did a psych degree with bio and goes to a naturopath to treat her chronic fatigue and systemic candida.

 

systemic candida? Did you mean GI candida?