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10.3.08

Alternative Therapies under Scrutiny

A dilemma such as what is discussed by Dr Wilkes below is something very familiar to me. I am hypertensive. But, I used to also take extra virgin coconut oil (evco) everyday and a lemon drink with honey. I made the decision against my doctor's advice. The first time she gave me my maintenance drug I wasn't on evco yet. Eventually, someone very credible suggested I also take evco. And I did. It was fine. I think I was having the time of my life. I was eating well, perhaps more than I should, confident my evco will be there to standby me.

Several check-ups later, I accidentally mentioned to my doc that in fact I was on evco. She was flabbergasted. She reminded me that not enough studies have been conducted on the efficacy of evco for hypertensives. I told her I was feeling better. She insisted that I totally eliminate it from my daily routine. To make a long story short, I reduced my intake from 6 tsps in divided dosage of 2 tsps per meal to just 2 tsps daily. I am not sure, but after doing this, I started feeling low on most days, seemed to have lost my energy, my zing so to speak. I am in a quandary. How can people like me debilitated forever, deal with the problem of complementing prescribed medication with alternative forms of treatment or products without earning the ire of our doctors? The issue is can I conclude that evco really did me good? Or was it just the placebo effect? Who knows? Today, I have totally stopped my evco because my cholesterol and triglyceride counts shut up like wow! To top it all, my doctor was actually blaming my evco intake for current condition :-( Aarrrgghh!!!

From a column published in www.sacbee.com

"Both Western medicine and alternative medicine benefit enormously from the placebo effect. Neither conventional medicine nor alternative medicine seems to hold a corner on ineffective treatment.

A substantial number of products that are available over the counter at the pharmacy, are prescribed by a doctor or are offered by an alternative provider simply don't work. In fact, 46 percent of treatments used in primary care offices aren't proven effective, and 5 percent are harmful but are still used. Sure, the throat spray may tickle our throat and drive attention from the pain, the cough syrup may taste awful and make us think it is a powerful medicine, and the echinacea may lead us to think we are developing fewer colds. But careful studies have shown that these agents do not work as advertised.

In contrast, another group of alternative therapies seems to be more than just placebos. For some illnesses, benefits have been found with touch therapy, herbs, vitamins and alternative approaches to illness including traditional Chinese medicine, chiropractic and Ayurvedic medicine. Californians love complementary and alternative medicine; more than a third of us use some type of it, spending over $2 billion a year.

Chances are you won't see these effective treatments offered in a typical American hospital, but I am not sure why. A study in this week's Archives of Surgery looks at the impact of massage on pain after major surgery. Researchers found that patients who received a 20 minute massage felt better for long periods. For many conditions, acupuncture is very effective and is far safer than typical pain medicines.

Despite a growing body of research, these treatments remain "alternative" and are available only outside of mainstream medicine. We have hospital departments of anesthesiology whose experts use all sorts of complicated, dangerous and expensive procedures to treat pain, but no one in the departments know acupuncture? Unlike most alternative therapy, acupuncture has been subject to more clinical research than many orthodox medical treatments, but it still is rarely used.

Medical schools don't include the content or the skills in their curriculum, so the next generation of doctors will probably be no wiser than the preceding one.

Worse yet, people don't talk to their doctors about their experiences with alternative therapy – perhaps because they think the doctor won't be supportive. They may be right. Patients are often embarrassed to let their doctor know what they have tried, or they worry they might be scolded. Patients have told me they worry that I might see their use of alternative medicine as a betrayal of their trust in me.

Doctors should encourage patients to openly discuss any interest in alternative therapies. I applaud patients' attempts to find relief for their suffering, and we need to recognize the limitations of conventional approaches. In fact, doctors often need to know about these treatments so we don't prescribe medicines that have harmful interactions.

Other treatments that Weil discusses – different breathing techniques for sinus infections, and vitamin combinations to slow the aging process – need to be subjected to careful, impartial clinical study. I am skeptical of their effectiveness, but once the studies are done, the results need to be believed and widely disseminated".

Written by: Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis.

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