Alternative medicine

Quite often I hear one of my patients say something like, “I take turmeric, CoQ10, krill oil and vitamin E, Calmag and biotin . . . that should work, right?" I take in a deep breath, and say, “Well, don’t quote me on this, but . . .”. “Oh, and Strauss Heart Drops . . . is that OK?” “I am sort of Old School on these treatments, you see, never got those classes. . . ”. “And I take my statin every third day – and I drink eight glasses of water too. . . ”. I clear my throat. “Most drugs need HPB approval through rigorous research and development protocols before they are allowed on the shelf. . . ”. “Oh, and the small white pill from my naturopath in Nepal.” I compose myself. I am not a policeman. I am a source of knowledge, assistance and wise counsel. I know about, and value, the placebo effect. I recognize that standard medications are not completely safe or effective. But sometimes I am put under pressure. “My doctor said my cholesterol numbers were OK after my bypass and carotid endarterectomy—surely low-fat yogurt and daily Zumba will suffice.” “The problem is, some of your therapeutic options are untested. Like, there is no randomized controlled trial of turmeric, with cohort size of 24,000, showing a clinical benefit meeting the accepted levels of statistical significance.” “If the drug companies had a patent on turmeric, wouldn’t they be pressing you doctors to sell it?” This point hits hard because maybe there’s a grain of truth there. I learned about Alternative Truths when Trump was in power. One of his publicity advisors explained it simply. You start out with two lies a day, and when they work, ramp up to eight lies a day. But alternative medicine has a longer history, born out of necessity, before the time of Roche and Bayer. When granny said “chicken soup and a raw onion. . . and off to bed before the moon rises,” well, that may have been the best available advice—albeit unsubstantiated by any double-blinded randomized controlled trial. Nowadays, the internet functions as a peripheral brain (sort of a third hemisphere, on your cellphone or desktop, just less bulky and squishy). It’s a source of undisputed knowledge, free of the inconvenience of face-to-face consultation, easily accessed, and conveniently linked to online pharmacies and health-food stores. “100% pure” makes me suspicious, knowing the only 100% certainties are death and taxes. I tell my patient, “I can’t vouch for the efficacy or safety of your supplement, but if it doesn’t harm you. . . the worst it can do is lighten your wallet.” There is a pause at the end of the line. “So, I can ditch that awful metoprolol, right, it causes so many side-effects. My pharmacist told me it would make my hair fall out, worsen psoriasis, prevent me getting exercise, make me tired and breathless, worsen “clod-y-Kay-shun, and….” By now I know she has the package insert by the phone*. “You are killing me, doc.” I sense the physician-patient relationship is under strain. “My boss has a second cousin in Florida who says his pharmacist swears by MEGA-X-TRICON-FATBURNER PLUS, and he gets them for $90/month, that’s half-price! What a deal! Is it my fault my genetics make me under-height for 300 pounds? This stuff reprograms your hypothalamic appetite centre, promotes cytokine-telomerase-5, 4-kinase cross-linkage, and is the best thing since sliced bread.” Alternative and complementary are interesting words. One indicates you have some choice in what goes into your body (we all do, right, just one works, one doesn’t). Complementary has a polite ring to it, and leads you to believe mainstream drugs might work better with them on board (like tomato ketchup on a burger). I once saw a young Indian woman in the ER. She had delivered a baby six months ago, and developed chloasma, an unfortunate discolouration around her eyes. She presented with generalized abdominal pain, and a normocytic hemoglobin of 80. Mild anomaly of liver function led to a normal ultrasound. A surgeon was unimpressed by it all. The unusual inclusions in her red cells were not malarial, but RNA clusters. The positive porphyria test was a red herring, but fit well with the final diagnosis of lead poisoning. Yup, she had gone to an Ayurvedic doctor whilst back in Agra and been given some pretty experimental treatment indeed. She declined to give me his name: She said her brothers would “deal with it.” She didn’t enjoy chelation therapy that much, I recall. So, what am I to do? I take some magnesium for my restless legs. But that’s about it. Wish I had more faith in old remedies. “Fillet of a fenny snake, In the cauldron boil and bake; Eye of newt and toe of frog, Wool of bat and tongue of dog, Adder’s fork and blind-worm’s sting, Lizard’s leg and owlet’s wing. For a charm of powerful trouble, Like a hell-broth boil and bubble.” (1,2) Having said that, would we ever have come across digitalis extract if Dr. William Withering hadn’t pressed the local sage with for her recipe for dropsy? (3). But then his renal patients didn’t do that well, I suppose. . . . References: (1) Shakespeare’s Macbeth (2) Witch’s Brew recipe written in Shakespeare’s Macbeth: Note that the ingredients may be tough to access at your local apothecary. Fortunately, some sources believe they represent the familiar names of common seeds and leaves, which your garden shop just might supply: Eye-of-newt = mustard seed (Brassica nigra) Toe of frog = Buttercup (Ranunculus acris L.) Wool of bat = Holly Leaves (Ilex aquifolium) Tongue of dog = Gypsyflower from the Genus Hound’s Tounge (Cynoglossum officinale L.) Adders fork = Least Adder’s-tongue (Ophioglossum lusitanicum L.) Blind-worm = Slowworm (Anguis fragilis) (3) An Account of the Foxglove and some of its Medical Uses, Withering, W (1785) * Discussion point: Why don’t we have patient medication-information sheets that quote the INCIDENCE of side-effects vs. potential BENEFIT of treatment? I mean, if I prescribe amlodipine for hypertension and the patient reads “this has been known to cause pancreatitis,” they should also know: risk of harm 10% reduction in annual stroke risk.

Casebook of a Community Internist

Alternative medicine

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Blog Author

Hector Baillie

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