March 10, 2005

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An alternative to alternative medicine

The interesting question is why people willingly pay hundreds, sometimes thousands of dollars for alternative medicine when the B.C. health plan supports real and efficacious procedures.

Tom KochSylvia has a problem. In fact, she has two. One requires an antidepressant, courtesy of marriage troubles and issues at work. The second is a thyroid imbalance requiring daily medication.

Her home problems are getting better and since she's coping at work Sylvia thinks she can stop taking the antidepressant. Because the drugs for her thyroid are expensive she'd like to stop them as well.

The problem is Sylvia wants to say no to drugs but her doctor is not enthusiastic. The protocols are working and while the antidepressant can be gradually discontinued the thyroid treatment is probably forever, he says. He's focused on her medical tests, on the benefits of the pharmacology, and not on what Sylvia says she wants.

An alternative medicine specialist listens to Sylvia a lot and says exactly what she wants to hear: "There's nothing really wrong with you, dear," the woman explained. "It's just that your body needs a little help."

Sylvia's doctor visits last about 10 minutes. At the alternative specialist's she sits and talks for perhaps 30 minutes. She explained her treatment plan would permit Sylvia to discontinue the anti-depressants and be weaned from the thyroid medication. The difference was fundamental, a matter of diagnosis.

"You have a prion virus in your thyroid," the alternative specialist told Sylvia. She was thrilled and had decided to tell her endocrinologist she was going the alternative route.

"What's a prion virus?" I asked Sylvia.

"I don't know," she replied. "Don't you know?"

As a gerontologist and medical ethicist I know a moderate amount of medicine. But I'm a layperson, not a physician, and am cautious about sounding more knowledgeable than I am. My job often involves translating between medicalese and normal speech, however, to the benefit of physician-patient-family relations.

"Well, prions are non-nucleated proteins implicated in Mad Cow disease, variant Creutzfeld-Jakob disease, and Scrapies," I said. "How they function, nobody knows. Viruses, on the other hand, are nucleated. They have DNA.

A prion virus would have to be a non-nucleated protein with a nucleus, a logical conundrum and a Nobel Prize discovery, if true.

I asked how this phenomenon was diagnosed and Sylvia said the therapist just knew. And how is it to be treated, I asked? "I put my hand in this bowl of water with this stuff in it," Sylvia said.

She said she didn't know how this cure worked and when I asked if it didn't sound a bit ridiculous she admitted that, yes, it did. Nor, she said, did she understand how this prion virus was supposed to affect her mood and her thyroid.

When I pointed out that discontinuing long-term use of powerful antidepressants requires time and care Sylvia said she hadn't known that, either.

"Why not treat your alternative therapist with the same skepticism you give to your physician?" I asked. "Ask for some papers on this prion virus, some explaining the efficacy of the treatment protocols, some proof that it is real."

It hadn't occurred to her that she should be as skeptical of alternative medicine as she was of mainline, clinical practice.

I see this a lot. People who are frustrated with their medical treatment, put their mind on the shelf and accept alternatives whose only justification is that they are not the slogging, boring, clinical protocols that are the state of the medical art today. The interesting question is why educated, sensible people like Sylvia willingly pay hundreds, sometimes thousands of dollars for alternative medicine when the B.C. health plan supports real and efficacious, if pedestrian, procedures.

One answer is the quack factor, the hoary tradition of charlatans who will spend time telling people what they want to hear.

"You're sick," the doctor says. "We can treat the symptoms with this medication and this program if you want to feel better." The alternative specialist takes 30 minutes to say, "You're not really sick. Your body needs a bit of help and here is the snake oil that will help you."

A deeper answer is our unreasonable expectations of medicine itself. We are nearing but not at the end of the dark ages of medicine. What we know is still outweighed by what is unknown. Medicine can treat the symptoms of a host of chronic ills that cannot be reversed. Sometimes it can't even do that.

And yet, medical knowledge has advanced so markedly in the last 50 years that we have come to expect unreasonable things from it and are disappointed when it can't deliver. We do not understand depression, the links between body chemistry and stress. We cannot cure Sylvia's deficient thyroid, but we can compensate for its limits. The idea of our physical fragility is troubling. The arenas of our ignorance are scary. As a result we seek the confidence of the alternative specialist no matter how foolish the advice may be.

An advocate of Chinese alternative medicine told me it was the equal of western medicine, and maybe more. "After all, it's been there for more than 2000 years," she said. "Yes," I replied. "And for most of those 2000 years people tended to die before they were 40 years of age. That's a swell recommendation."

A chiropractic specialist told me the flu could be prevented with a "slight adjustment at C-3." I asked how a respiratory virus could be knocked out with cervical spinal manipulation. He shrugged.

People impatient with modern medicine send me to web pages so I can see the proof of the alternative treatment they wish to try. Mostly, the web pages have the feel of science and objectivity. A careful read shows there is nothing but puffery inside.

A treatment for rheumatoid arthritis one client recommended I read was, once I got down to the fine print, rice flower and sugar. She took it for nine months and in the end needed two hip replacements instead of one.

 Sure, some physicians have forgotten how to talk to patients. But we, too, share the blame. Our expectations don't match the reality of medicine and the result is our own disaster, the failure of our own treatment.

Begin with this: the body is fragile and medicine is ignorant. Alternative treatments are rarely the answer, however. Clunky and difficult as clinical medicine is, it's better than the pseudo sciences.

It's better to take the thyroid medicine than to live without, an antidepressant than to live in the darkness. Better to accept our fragilities, and the treatments they require, than to seek a status of physical invincibility that neither clinical medicine nor its alternative competitors can provide.

Tom Koch is an adjunct professor of gerontology and a forum associate at the David Lam Centre for International Communication, SFU. His most recent book is The Wreck of the William Brown.

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