As a doctor I have a responsibility to my patients. I have the responsibility to do my best to diagnose and treat any patient that comes my way. I also have the responsibility not to waste my patients time, money, hope and health by offering worthless therapies.
That can be hard at times. Because when I see someone who is ill, who is suffering, and who comes to me for advice, I want to help. I want to make them better. Being an infectious disease doctor I do not often see medical conditions for which I can offer nothing. Occasionally I see one of the chronic fatigue states and I hate it when I have to tell the patients that no, as best as I know, I have nothing to offer you.
And when patients ask me about various pseudo-medical interventions I usually feel obligated to give the same response. No, acupuncture or colloidal silver or those herbs or that homeopathic nostrum or [fill in the blank] will not help your illness. As much as I would like to be able to offer something, I can’t do it. I feel obligated to practice within the bounds of reality.
Other institutions have different standards.
As you are aware, acupuncture, chiropractic, rebirthing, regression therapy, guided imagery, and reiki are all pseudo-medical nonsense. As is Breath therapy, which I had never heard of…
I do not expect pseudo-medical providers to know any better. They have drunk the Kool-Aid. But I would not except a medical clinic to have on their website phrases like…
All examples of what the Cleveland Clinic is offering, and more, in their Integrative Medicine Center.
Really. Reiki. No homeopathy. Yet. But Reiki. Reiki!
My Dad always told me you can judge a person by the company they keep. You offer Reiki, no matter how potent your other high vibrational energies might be, I cannot help but suspect you and I have different concepts as to our responsibilities to our patients.
And now, according to a press release, they have added Chinese Herbal Therapy.
Such a collection of pseudo-medicines in one medical clinic. And I hope the picture is not from the Cleveland Clinic. That bare finger next to the needle gives me the infection control willies…
(March 2015) Acupuncture Provides Minimal Benefits After Study Design Bias Is Removed
“In our study, we enrolled participants who did not know the trial was examining acupuncture, whereas in other studies on acupuncture, subjects were aware that the focus was on this treatment,” said lead investigator Rana Hinman, PhD.
The researchers and experts are touting the study’s “Zelen design” (originally proposed by Harvard School of Public Health statistician Marvin Zelen) for overcoming a bias that previous trials on the topic have included by randomizing patients before consent to participate has been sought. Dr. Hinman said that individuals inclined to volunteer for an acupuncture study are also more likely to look favorably upon the approach. This increases the chances of a positive effect if they are administered either the treatment or a sham…
He said these results—like in some prior studies—show that on average, acupuncture is associated with slight and short-lived benefits. He noted that some individuals who were administered acupuncture and “other alternative and complementary modalities, or even treatments for pain described as placebos” have also reported improvement.
“These ‘responders’ should not be dismissed as gullible,” said Dr. Hadler. “There are certain individuals who, because of their worldview and beliefs, will find comfort in alternative and complementary treatments that have been proven to be no more effective than placebo.
“Whether it is ethical for clinicians to offer patients these ‘comforting’ treatments remains a topic of debate.”
What Homeopathy & Spine Surgery Have In Common
Should health insurance pay for placebo therapies?
Wednesday, 11 July 2012
Steroid injections for low back pain
The Cochrane review on injections for low back pain concludes: “There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain”. The injections contain corticosteroid (‘steroids’, ‘cortisone’) mixed with local anaesthetic and are injected into the epidural region or the facet joints of the lumbar spine. The injections have been compared to placebo injections and to other treatments and, without going in to all the detail, they basically don’t work…
But surely some studies show a benefit to these injections? Again, yes, but those studies are usually not ‘blinded’ and do not use a true placebo, so we are not allowing for the placebo effect and the other reasons why people get better without treatment…
How big is the problem? There are hundreds of thousands of back injections performed each year worldwide. It is routine practice for general practitioners and spine specialists, and it is big business for interventional radiologists. In the US, the rate of epidural injections in the Medicare population increased more than three-fold between 1994 and 2001 (here) and more than doubled in the 10 years leading up to 2006 (here). The increase in costs per injection means that the cost of spinal injections has increased several hundred percent (here)…
We are witnessing an increasing divergence between the growing evidence that these injections do not work, and the growth in the number of these injections being performed. There are many likely explanations. Firstly, it is standard practice, so it is easy to justify; if everyone is doing it, then you cannot be criticised for doing it. Also, as I have said before, patients want some kind of treatment and at least the doctors feel as if they are “doing something”. Most doctors probably believe (from what they see, from tradition, and from wishful thinking) that the injections work. Like Bruce Willis in The Sixth Sense, doctors are ‘seeing what they want to see’. They give the injections and some patients feel better afterwards, and they impute cause-and-effect. Very human of them, but not very scientific. The science tells us that they were just as likely to get better with a placebo. Also, of course, a lot of people are making a lot of money from these injections.
(2009) Overtreating Chronic Back Pain: Time to Back Off?
Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain…
(July 2015) Physical Therapy, Surgery Yield Similar Results for Lumbar Spinal Stenosis