The Herbal Medicine debate continues.

Sarah Hemple has done a very nice job describing her personal medical experiences, which definitely helps give context to her other commentary. (It does make me wonder how much of her positive experiences with alternative therapy she attributes to placebo effect.) Since I am both lazy and less eloquent, I will provide a shorter version of my background:

Similar to Mr. Allen, I have seen stupid doctors, poor nurses, horrible insurance and HMO companies, and virtually every possible ethical and moral failing occur in the medical profession. My mother came very close to death in 1996 from a botched and unauthorized hysterectomy that caused ureic poisoning from a cut ureter. I’ve personally received some horrible medical treatment, namely in the form of inappropriate and potentially liver damaging prescriptions. I’ve also seen what Sarah would consider poor long term care strategies applied to my family members (Mother has M.S., paternal grandfather was paralyzed for 30 years following a car accident, etc). I do not have any illusions whatsoever about the medical community’s ability to screw up. (Not to mention two semesters of Torts, taught with an emphasis on medical malpractice law)

As a result, I most certainly do not recommend that anyone blindly trust medical advice, I’m skeptical about EVERYTHING, not just alternative medicine. In a perfect world, everyone would be able to maintain a long-term, preferably life long relationship with a trusted family practitioner, preferably a D.O. or at least an M.D. with a patient care focused education. Since that isn’t an option for most of us, whenever possible, I think in all non-urgent medical situations, one must educate themselves as much as possible, and do a great deal of risk balancing. This is where I find no substitute for double-blind, statistically valid studies. Also, as I tried to point out before, this is why I hate to generalize about ALL antibiotics, I want to look up the studies, probably on medline for a specific drug and weigh the risks.

Sarah apparently in non-emergency situations reaches first for alternative therapies, to quote “I think that lifestyle changes ought to be a first step, nutritional support through supplements, herbs and other alternative practices such as chiropractic, acupuncture, etc. only then should the patient turn to pharmaceuticals. I have no issue with being skeptical of pharmaceuticals, AS LONG AS ONE IS EQUALLY skeptical and demanding of the alternatives. Why should supplements, herbs, etc be given preference to pharmaceuticals? It certainly is not their amazing performance and lack of side effects. With the exception of a healthy diet, exercise, and limiting substance abuse, double-blind studies are not kind to non-pharmaceutical therapies. Steven Bratman has written a very nice and concise explanation of what I’m trying to say about double-blind studies, and I HIGHLY recommend that everyone read it. I am also very willing to argue or discuss his conclusions if anyone is interested.

As far as the placebo effect, I don’t have a problem with people knowingly finding a alternative therapy that they like for placebo reasons, as long as possible health risks are weighed. That is, there probably is a alternative therapy out there for everyone that has a beneficial placebo effect. Maybe going to a chiropractor and getting what amounts to a decent backrub, or getting poked with needles, or magnets, or whatever. As long as a person is doing it with their eyes wide open (i.e. avoids stroke risking abrupt c-spine manipulation, etc), I actually think it can be a good thing.

In the last paragraph, I alluded to a internal, psychological factor in the placebo effect. This is, I believe a very powerful and difficult to analyze factor, where a therapy that is functionally useless may create vastly improved sensations of well being because it happens to trigger or satisfy a certain psychological need. Maybe that need relates to tradition, or religion, or an experience growing up, or a desire to fit in, or whatever…the possibilities are endless. Perhaps the most interesting thing that I typically observe is a gender difference (Note, this IS NOT a personal attack on Sarah, and I nearly didn’t post it because I’m afraid it will appear so). I would say that many more women than men, at least in my social circles are interested in alternative therapies. Why? I don’t know, I’m working on that part. If I had to guess, I suspect that there is a psychologically strong appeal to…old traditions and pseudo-traditions of female wisdom, sort of like midwifery. I’m very interested in possible comments on the subject. And, of course if that came off as misogynistic let me know and I’ll try to rephrase it.

Finally, areas I can see the discussion going in:

1. I think Sarah hasn’t really responded to my criticisms of self-observation, and I’d love for her to discuss her views on the placebo effect.

2. Topics I can see the discussion expanding into: homeopathy, vaccinations, Faith-based healing/ “power of prayer”, Stem cells, etc. Since I’ve found the discussion interesting up to this point, I’m willing to pretty much go wherever people want with it.