The Superiority of Alternative Medicine

At the Ramada, I cared for a lady whose eyes were red and itchy. She had no allergies, and I saw no evidence of an infection. I suspected something was irritating them, and she had been using several over-the-counter eye-drops. Drops themselves can irritate eyes, especially with persistent use, so I told her to stop.

No eye drops for an eye problem?.... She looked uneasy at this suggestion, so I left a bottle of antibiotic drops but told her to call in two days if she still felt bad and wanted to use them. This is another occasion why so many patients prefer alternative medical practitioners (herbalists, nutritionists, acupuncturists…). No alternative healer tells a patient: “Don’t do anything. This will go away.” There’s always a treatment.

Isn't Science Wonderful - Continued

As I wrote last time, doctors treat strep throat with an antibiotic. Does it work?

That seems a no-brainer because antibiotics definitely kill strep bacteria. But the answer turns out to be….maybe. In scientific studies, giving antibiotics to patients with strep throat is not dramatically effective. Some doctors suspect they don’t work. This contrasts vividly with treating strep infections in other areas such as the skin where it’s often obviously lifesaving.

“Wait a minute!!” assert experts including my professors in medical school. It’s true that strep throat goes away in three to five days even if not treated, but doctors must treat in order to prevent rheumatic fever, a disease that can produce devastating heart disease. Scientists don’t understand why, but a small percentage of strep victims go on to develop rheumatic fever. Antibiotics lower the risk.

Are they right? Again science delivers the answer: maybe. Evidence for preventing rheumatic fever in America comes from a study conducted sixty-five years ago when rheumatic fever was common. It’s rare now. I’ve never seen a case. Everyone agrees it wasn’t a terrific study.

Some doctors believe that rheumatic fever is so rare in the US that giving an antibiotic is more likely to cause harm (yes, antibiotics can cause harm) than benefit.

While it’s fun to make controversial statements in this blog, with patients I stick to the standard of practice. This means I sometimes give treatments whose scientific basis is weak. If you prefer therapy that’s guaranteed, you must stop seeing scientific practitioners like me and seek out alternative or complementary healers. Google “alternative medicine.”  You’ll notice that their treatments always work.

Why Doctor Oppenheim Isn't Rich

The better we conventional doctors handle a problem, the less you’ll read about “alternative” treatments. Your local health food store doesn’t sell an herbal remedy for appendicitis. Don’t laugh. Until a century ago victims died after weeks of agony. Then we discovered that snipping off the appendix (something any bright high school student can do) cured it. This is one of many genuine medical miracles we take for granted. Some of us remember the herpes panic of the late seventies. The AIDS panic that followed overshadowed it, but Time magazine and Newsweek published cover stories on herpes, and the New York Times described it as the twentieth century bubonic plague. Alternative remedies were everywhere, not a few sold by entrepreneurial doctors. Then a good drug appeared, and the market for herpes cures dried up.

On the other hand, doctors don’t do so well treating obesity, arthritis, aging, or senility. If you want a superb treatment that conventional doctors ignore, check the internet or a bookstore. You’ll find plenty.

Many alternative healers are M.D.’s like me. They have names like Deepak Chopra and Andrew Weil and Mehmet Oz. They agree that scientific medicine has much to offer but insist that it is merely one of many routes to healing. 

They assert that it’s equally important to tap our spiritual energies, maintain a healthy optimism, promote natural healing with balanced and pure nutrients available through their web sites, and keep an open mind to cures wrought by eastern religion, nonwestern medicine, and pioneering researchers ignored by the establishment.

It is my belief that this is not true and that they are quacks. In my opinion (my lawyer insists that I add this). But as someone convinced that science is the road to truth, I’m obligated to present evidence. So….

I write an obscure blog. Weil, Oz, and Chopra write bestsellers. My books never sold much (I’ve written five, all commercially published). There are no ads on my blog. Weil, Oz, and Chopra have plenty. They sell wonderful stuff on their web sites. They appear on TV all the time. No one asks for Doctor O.

It doesn’t look good for me. 

The Miracle Game

A guest’s ankle injury didn’t seem serious, so I told her we’d wait a day before deciding on an x-ray. At her request, I wrapped the ankle in an elastic bandage while explaining that orthopedists believe that elastic bandages accomplish little. 

As I wrapped, I mused on the superiority of western medicine. I have little respect for alternative, complementary, holistic, herbal, or natural healing systems, but I admit that all popular and media doctors disagree, and they enjoy a far larger audience than this obscure blog.

My reasons have something to do with the fact that we genuinely help patients, but I prefer to stress how often we don’t. Alternative healers never say: “This treatment could be better…” or “We thought we understood this disease, but we were wrong…” or “We screwed up…” Scientific training hasn’t prevented me from making mistakes, but I hope I learn from them. 

When I’m feeling particularly hostile, I challenge alternative medicine fans to play the miracle game. I’ll name one of our miracles; then it's your turn. No fair using a secret cure. It has to be something we all agree on.   

My first western medicine miracle: the appendectomy. Appendicitis victims once died after weeks of agony. Then we discovered that snipping off the appendix (something any bright high school student can do) cured it. We take this for granted, but it’s a miracle that's saved millions of lives. Now let’s hear yours….

Things I Say All the Time

Long experience has taught me that patients love to hear the following.

1.  “This isn’t a serious problem, and it never turns into a serious problem.”

Doctors know that many tiresome ailments such as hemorrhoids, bladder infections, migraine, or herpes don’t turn into something worse, but patients don’t know this. A doctor must tell them. 

2.  “I want you to call me any time.”

Doctors say this all the time, but you know what happens when you try. I show guests my cell phone and promise to answer in person. Naturally, I do this because I’m a compassionate physician, but there’s an element of self-interest. If guests aren’t getting better, I want them to tell me – not the hotel.

3.  “Staying in bed won’t make this go away faster.”

Travelers waste valuable days in a boring hotel room, so I try to take the pressure off. This myth is so universal that when I reassure non-English speaking guests, I ask them what I’ve just said. Almost always, they repeat it back minus the negative.

4.  “You’ll feel under the weather for a few days; then you’ll feel better.”

Guests may suffer for weeks, but once they see a doctor, they want things to move quickly. If I don’t explain that this might not happen, I may hear from them the next day.

5. “It’s not your fault.”

A baleful consequence of the popularity of alternative medical theories is that patients believe they’re responsible for getting sick. Mostly, they’re not.  

Three More Great Sins of the Medical Profession

4.  Doctors spend too little time explaining how to relieve stress.

     Probably… Stress makes everything worse but doesn’t cause anything. Seeing a doctor for stress results from what I call the “medicalization of society” - the notion that life’s difficulties (a hateful job, unsatisfying sex life, shyness) represent a medical problem. There’s no harm in this; a good doctor can listen sympathetically and make sensible suggestions which require no medical training.

5.  Doctors don’t pay much attention to diet, rest, exercise, and other natural methods of treating illnesses.

     True and proper. Diet, rest, etc. play an essential part in preventing disease but drop to minor roles once you get sick... A perfect example were tuberculosis sanitariums, the oldest government supported medical program. They began appearing in the nineteenth century. Patients received nutritious food and plenty of rest in a healthy, rural environment.  They were discharged (sometime after years) when their TB became inactive. No one was cured, and many relapsed. When drugs appeared after 1945 sanitariums vanished. Nowadays doctors encourage TB patients to eat a nutritious diet, but they’ll get better even if they don’t – provided they take their drugs.

6.  Doctors ignore alternative and folk medical practices.

     I notice enthusiasts treat folk medicine with respect, but no one advocates folk dentistry...

     In fact, many alternative practices work but less dramatically than advocates claim.  Acupuncture definitely relieves pain. Unfortunately, its action is unpredictable and not always complete. Despite vivid reports, Chinese surgeons rarely use it in place of anesthesia... Chiropractic manipulation relieves some backaches for a limited time.

     The better doctors handle a problem, the less you’ll read about “alternative” treatments. Your local health food store doesn’t sell an herbal remedy for appendicitis. Don’t laugh. Appendicitis is fatal; until a century ago victims died after weeks of agony. Then we discovered that snipping off the appendix (something any bright high school student can do) cured it. Today no one searches for an alternative treatment of appendicitis. 

     On the other hand, doctors don’t do so well treating obesity, arthritis, aging, or senility. So if you want to find an alternative remedy that doctors have stupidly ignored, you’ll find plenty.  Good luck with them.

Phrases Patients Love to Hear, Part 2

4.  “Staying in bed won’t make this go away any faster.”

Many laymen believe illness requires rest. They skip work or school. Mothers go to great (and futile) length to keep children immobile. Travelers waste days in a boring hotel room. This myth is so universal that when I reassure non-English speaking guests, I ask them to repeat what I’ve just said. Almost always, they miss the negative.

5.  “The fever (or vomiting or diarrhea) won’t harm you.”

Temperature by itself - even to 104 - won’t damage a healthy person.  Patients should pay attention, but they needn’t worry that death is near. When patients ask for a genuinely dangerous temperature, I answer “over 105,” but this is less helpful than it sounds because at this level, patients feel very bad. Similarly, healthy laymen fear that a few episodes of vomiting or diarrhea will produce serious malnutrition.

6.  “You’ll feel under the weather for a few days; then you’ll feel better.”

Patients may suffer for a week, but once they see a doctor, they want things to move quickly, so I warn guests that this might not happen. In my experience, if I neglect this, patients become concerned if they’re not feeling better the next day and take advantage of #3.

7.  “It’s not your fault.”

All our efforts at patient education plus the popularity of alternative medical theories have convinced Americans that they are responsible for getting sick. This is occasionally true but mostly not.

Why Americans Don't Eat Horse Meat

Doctors grumble at the popularity of alternative medicine, but the truth is that we still have a monopoly. This is not so in other civilized nations. In France and Germany, for example, herbal medicine is mainstream - i.e. health insurance pays for it.

When Americans get sick, almost all head straight for a medical doctor. From a doctor’s view, that’s the right decision. Scientific medicine works. But that’s not the reason. The idea that scientific explanations are the best has always been a minority view, and recent nutty events haven’t changed matters. In a free election, ghosts would win and evolution lose -- by a landslide.       

Americans mostly prefer medical doctors just as we prefer baseball and big cars. It’s an American thing. We don’t eat horse meat because…well, we don’t.

We Work Miracles But Not All the Time

Practitioners of complementary medicine (alternative medicine, herbal medicine, homeopathy, naturopathy, acupuncture, etc.) always know what to do. That’s because all follow a theory that explains (1) what causes illness and (2) the proper treatment. This is very satisfying.

Doctors like me don’t have a theory of disease. I hate to say we use science because many people – some with college degrees – believe “scientists” are like “Episcopalians” or “Republicans.” They hold certain opinions, but it’s OK to have other opinions. It’s a free country.

Rather than say doctors are scientific I like to say we search for the truth. We try to find out what makes people sick and then what works to help. This is hard. Throughout history everyone assumed that the best doctors were wise, but this isn’t so. Wise doctors throughout history answered big questions, but they were usually wrong. Hippocrates came up with a few gems that everyone quotes, but most of his advice is garbage or the usual platitudes doctors deliver when they don’t understand what’s going on (avoid stress, eat nutritious food,…).

By searching for the truth (remember that’s another word for science) doctors have turned up miracles. An appendectomy or a kidney transplant is a miracle. The same is true for antibiotics, vitamin B12, immunization, anesthesia, even the discovery of germs (no wise man in any other culture came up with the idea that tiny bugs cause disease).

Doctors work miracles but not all the time; surgeons do better than medical doctors. I help most patients, but I don’t save lives often. When I do, I write about it here.

Doesn't This Seem Dumb?

In the old days doctors took for granted that anyone who practiced alternative medicine (herbalists, naturopaths, homeopaths, Ayurveda, holistic healing) was a quack, but times have changed. The establishment (even the AMA) urges us to show respect. All popular media doctors (Oz, Weil, Pinsky, Chopra) emphasize that conventional medicine, while useful, ignores life-saving natural, traditional, spiritual, mind-body, and otherwise unorthodox treatments. 

Here’s something that puzzles me. Alternative medicine is respectable, but no one gives a damn about alternative surgery.

If a cool guy breaks his leg or cuts his face or suddenly can’t pee or gets a piece of dirt in his eye or sees blood pouring out his anus, he never ramps up his yoga or seeks a healing herb.

He heads straight for a conventional doctor like me. We take out our tools and fix him.

Doesn’t this give the impression that orthodox medicine works for urgent problems and those visible to the naked eye? Alternative medicine is OK if your problem is not urgent and not visible.