A Lengthy Absence
Well, I'm back after a few very busy weeks. Soon after my last post it was time for final exams, and then afterward I taught a "May-mester" course--25 hours of class time in 2 weeks. Now it's time to catch my breath as I look forward to a summer of writing.
The mini-mester course was composed of RNs who are returning for their bachelor's degrees. This may seem odd to some, but the fact is, nursing has had 3 levels of educational entry for decades. Originally nurses were trained in hospital-based schools of nursing. This provided a labor supply, and guaranteed that student nurses would have practical, clinical training sites, as well as training that would teach them a specific hospital's procedures and inculcate them into that specific hospital's culture.
This passed out of fashion in most parts of the country, in part because nursing students were being treated as a source of labor more than they were being treated to an education that would have applications outside of this or that specific hospital. Also, as health care has matured, many smaller hospitals have closed specialty units such a pediatrics and obstetrics, that form key parts of a nurse's education. Interestingly, Pennsylvania has more remaining hospital-based diploma programs than any other state, although many, like a program in Lancaster PA, have converted into chartered degree granting institutions, providing a more rounded experience that includes things typical in a college education (like history, philosophy, writing, and so on).
Anyway, there are still a lot of community college-based programs throughout the U.S. So there are still lots of 2-year programs out there (although they consist of so many courses, it usually takes 3 years to get through). Many colleges and universities offer so-called "RN to BSN" programs, composed of students who may have practiced little yet, or may have been practicing for many years. Part of my teaching is in such a program.
Why do they go back to school?
In the past it was mostly to secure a promotion track with their employer, or to ready themselves for graduate school to become a nurse anesthetist, nurse practitioner, or educator. By law and custom a master's degree is required for these sorts of advanced practice roles.
Today, many return because their employers require the bachelor's degree. Research that emerged in the early 2000s found some evidence of an improved safety margin when hospitals have a larger number of BSNs working in them. That's good for patients, and it makes hospitals more competitive.
Ah, but what can one teach such nurses? After all, they are already licensed. However if the research found this additional safety margin, then there must be some additional tools we can provide these students. Over the next few posts, I'll discuss what these RNs value in their extra education. Those things speak to several important and interesting features of our health care system.
Saturday, May 21, 2016
Wednesday, May 4, 2016
The Same Old Arguments
I'm sitting here watching a recording of Frontline called "Supplements and Safety," which aired on PBS in January of this year. What strikes me early on is the editorial construction of the piece: doctors soberly reporting on their grave concerns about the cases of injury and harm, the lack of quality controls, and the mystery of what's in those dietary supplements. The manufacturers of supplements are shown to be ruthless mercenaries, and the FDA as hapless regulators who may be in the pockets of Big Business. Consumers are rubes, with selected attention paid to those grievously harmed by this relationship.
I don't object to the basis of their journalism. They accurately point out problems with the lack of quality controls in the supplement industry, the complexity and nuance of the data that are said to favor supplement use, and the risks of taking high doses of things you can't fully trust.
What they don't cover is why people do this. There's also a real effort to pump up the emotion, and you accomplish that by keeping arguments pretty simplistic.
In 1994 the Dietary Safety and Health Education Act was passed. The law emerged from the acrimony that resulted from pitting two forces against each other whose differences were irreconcilable. One force was Organized Medicine, led by Dr. David Kessler, then head of the FDA. He saw a problem with supplements--and there was a problem--and he wanted to do something about it.
Unfortunately, he fell prey to the narrow lens of empirical medicine, which tends to view things in a very reductionist manner. Also, it tends to be very chauvinistic. Since the mid-1800s, Medicine as profession has done everything in its power to make people dependent on its methodologies. Medicine condescends to people, branding their ideas, their experiences, and their genuine interests in their own health as wrongheaded and just stupid. Notwithstanding that some individual doctors who view justice and holism as worthy characteristics of medicine in society, as an industry, Medicine has consistently been as greedy and prejudicial as any industry.
On the other side was the supplement industry--not even half of what it is now--still a behemoth, and they started a campaign against the FDA's efforts to regulate supplements. They were very successful, and today the DSHEA's regulations enforce a circumstance that benefits industry at the expense of consumers.
What the Frontline broadcast doesn't get into is the culpability of Medicine and the zeal of the "lifestyle police" in the creation of this circumstance. In the early 1990s, Medicine and The Scientists could have partnered with consumers. They could have tried to think outside the box. During one sequence "Supplements and Safety" talks about Ephedra, known in Chinese medicine as ma-huang (Ephedra sinensis). The use of this herb goes back thousands of years and its use is safe and well-documented. Ephedra is an effective nasal decongestant and energy builder, when indicated.
Who decides when its indicated and how it should be used? How about specialists in Chinese medicine? That's a novel idea that didn't occur to the short-sighted zealots who were crafting a law that would make doctors and the pharmaceutical industry the arbiters of what's "good" for us. In 2004, 10 years after DSHEA, ephedra was pulled from U.S. markets after a number of deaths occurred from overdoses of weight lifting and energy supplements containing ephedra.
Thus, a perfectly useful and effective drug was removed from everyone's use because of the same old argument between the Supplement Industry and Organized Medicine. Had it even occurred to the zealots that giving licensed practitioners of other medical arts a say in the regulation of these products, would encourage partnerships with Medicine that would improve both the health and the safety of consumers?
The problems are threefold. First is money. Anyone with something to gain or lose is going to have a hard time remaining intellectually neutral in any argument when this is the case. If supplements are better regulated, to the point where some supplements are restricted to vetted practitioners of medicine or some other medical art, they lose. Doctors have something to lose when people treat themselves, and when practitioners other than physicians enter the field.
The second is chauvinism. This is a kind of intellectual classism which tends to ignore or denigrate native or folk knowledge. For example rather than viewing supplement use as the province of the ignoramus, doctors could try curiosity. Curiosity teaches us new things, and displays of genuine curiosity open rapport with patients. This is what I teach my students.
The third is rigidity. Medicine and The Scientists are fond of saying, "Where are the controlled clinical trials?" "This hasn't been proven!" Mark Tonelli, a physician, and Timothy Callahan, a researcher, both from the University of Washington School of Medicine write in Academic Medicine (2001) that the demands that complementary and alternative medicine (CAM) fit into evidence-based practice models is a philosophical demand that doesn't cohere with the various models and understandings of "disease" and "health" in those methods.
It's not that we can't explore the value of CAM methods--or supplements themselves for that matter--using science. We can, we just have to make sure the methods we use are appropriate to the particulars of the thing were exploring! There's nothing scientific about trying to jam a square peg into a round hole. Nor must we simply ignore the square peg and allow it to remain unexplored. (This also argued by Tonelli and Callahan--they aren't giving CAM a pass! They are just suggesting that Science amp up its game, and not rely on models of study that are becoming increasingly limited in their ability to determine value.)
This is about the "same old arguments." Both sides lack verity, both are wrong, because they lack imagination, empathy, and desire to do the best for the most. What would that be? Partnerships that don't start from financial interest or intellectual chauvinism would be a start. The Frontline special shared some initiatives in the supplement industry that would improve quality and safety. These partnerships between researchers and the industry offer us hope that the same old argument is changing.
I'm sitting here watching a recording of Frontline called "Supplements and Safety," which aired on PBS in January of this year. What strikes me early on is the editorial construction of the piece: doctors soberly reporting on their grave concerns about the cases of injury and harm, the lack of quality controls, and the mystery of what's in those dietary supplements. The manufacturers of supplements are shown to be ruthless mercenaries, and the FDA as hapless regulators who may be in the pockets of Big Business. Consumers are rubes, with selected attention paid to those grievously harmed by this relationship.
I don't object to the basis of their journalism. They accurately point out problems with the lack of quality controls in the supplement industry, the complexity and nuance of the data that are said to favor supplement use, and the risks of taking high doses of things you can't fully trust.
What they don't cover is why people do this. There's also a real effort to pump up the emotion, and you accomplish that by keeping arguments pretty simplistic.
In 1994 the Dietary Safety and Health Education Act was passed. The law emerged from the acrimony that resulted from pitting two forces against each other whose differences were irreconcilable. One force was Organized Medicine, led by Dr. David Kessler, then head of the FDA. He saw a problem with supplements--and there was a problem--and he wanted to do something about it.
Unfortunately, he fell prey to the narrow lens of empirical medicine, which tends to view things in a very reductionist manner. Also, it tends to be very chauvinistic. Since the mid-1800s, Medicine as profession has done everything in its power to make people dependent on its methodologies. Medicine condescends to people, branding their ideas, their experiences, and their genuine interests in their own health as wrongheaded and just stupid. Notwithstanding that some individual doctors who view justice and holism as worthy characteristics of medicine in society, as an industry, Medicine has consistently been as greedy and prejudicial as any industry.
On the other side was the supplement industry--not even half of what it is now--still a behemoth, and they started a campaign against the FDA's efforts to regulate supplements. They were very successful, and today the DSHEA's regulations enforce a circumstance that benefits industry at the expense of consumers.
What the Frontline broadcast doesn't get into is the culpability of Medicine and the zeal of the "lifestyle police" in the creation of this circumstance. In the early 1990s, Medicine and The Scientists could have partnered with consumers. They could have tried to think outside the box. During one sequence "Supplements and Safety" talks about Ephedra, known in Chinese medicine as ma-huang (Ephedra sinensis). The use of this herb goes back thousands of years and its use is safe and well-documented. Ephedra is an effective nasal decongestant and energy builder, when indicated.
Who decides when its indicated and how it should be used? How about specialists in Chinese medicine? That's a novel idea that didn't occur to the short-sighted zealots who were crafting a law that would make doctors and the pharmaceutical industry the arbiters of what's "good" for us. In 2004, 10 years after DSHEA, ephedra was pulled from U.S. markets after a number of deaths occurred from overdoses of weight lifting and energy supplements containing ephedra.
Thus, a perfectly useful and effective drug was removed from everyone's use because of the same old argument between the Supplement Industry and Organized Medicine. Had it even occurred to the zealots that giving licensed practitioners of other medical arts a say in the regulation of these products, would encourage partnerships with Medicine that would improve both the health and the safety of consumers?
The problems are threefold. First is money. Anyone with something to gain or lose is going to have a hard time remaining intellectually neutral in any argument when this is the case. If supplements are better regulated, to the point where some supplements are restricted to vetted practitioners of medicine or some other medical art, they lose. Doctors have something to lose when people treat themselves, and when practitioners other than physicians enter the field.
The second is chauvinism. This is a kind of intellectual classism which tends to ignore or denigrate native or folk knowledge. For example rather than viewing supplement use as the province of the ignoramus, doctors could try curiosity. Curiosity teaches us new things, and displays of genuine curiosity open rapport with patients. This is what I teach my students.
The third is rigidity. Medicine and The Scientists are fond of saying, "Where are the controlled clinical trials?" "This hasn't been proven!" Mark Tonelli, a physician, and Timothy Callahan, a researcher, both from the University of Washington School of Medicine write in Academic Medicine (2001) that the demands that complementary and alternative medicine (CAM) fit into evidence-based practice models is a philosophical demand that doesn't cohere with the various models and understandings of "disease" and "health" in those methods.
It's not that we can't explore the value of CAM methods--or supplements themselves for that matter--using science. We can, we just have to make sure the methods we use are appropriate to the particulars of the thing were exploring! There's nothing scientific about trying to jam a square peg into a round hole. Nor must we simply ignore the square peg and allow it to remain unexplored. (This also argued by Tonelli and Callahan--they aren't giving CAM a pass! They are just suggesting that Science amp up its game, and not rely on models of study that are becoming increasingly limited in their ability to determine value.)
This is about the "same old arguments." Both sides lack verity, both are wrong, because they lack imagination, empathy, and desire to do the best for the most. What would that be? Partnerships that don't start from financial interest or intellectual chauvinism would be a start. The Frontline special shared some initiatives in the supplement industry that would improve quality and safety. These partnerships between researchers and the industry offer us hope that the same old argument is changing.
Monday, April 25, 2016
Influenza Week
I've seen a number of cases of the flu--or at least what appears to be the flu--this month. Clinically, the flu is marked by sore throat (usually), high fever (or high-ish, low 100s F), muscle aches, fatigue, and often a cough. However, like any bug, you need a lab test to be sure, and we hardly ever get those, unless lab facilities are close by and insurance is really good. There are innumerable respiratory viruses and many potential bacterial infections. The former must be treated with antivirals within about 2 days, and the latter often do but don't always respond to antibiotics (for example, whooping cough).
Anyway, I had no opportunity to culture anyone anyway. Helpful remedies have been Bryonia and Nux moschata--in the latter case especially sleepy flu cases! (And it is just a few cases.)
"Did you have your flu shot?" People might ask.
In general, I avoid vaccination for non-fatal diseases, and despite what some TV doctors say about it, the flu isn't usually fatal. You just feel like you want to die.
Why? Hmm, I have a sense that we need some sicknesses to maintain some ecological balance to our world. Sickle cell trait confers some protection against malaria. Cancers have been known to recede during periods of fever from infection. My sense is not entirely a random hunch.
A physician assistant writes in The Clinical Advisor, an online, sponsored medical magazine, that there are undisclosed financial relationships between flu committee members at the CDC and vaccine manufacturers. Further, he notes that dangers may be overstated (especially in terms of fatalities, which are low).
One might ask: is any fatality acceptable? A philosophical question, and unanswerable in a practical sense because people value different things. Much of what passes for the "vaccine controversey" is really a discussion about the value of the public good versus the value of the individual's good. This is a discussion--or just a cussin' out sometimes--between those who have set their needle for public good to a point which they believe is good and just, and those who set it a bit farther back. This becomes a very complex equation when you consider all the forces at work in someone. Multiply those "someones" and society's decisions become vexing indeed.
By "forces" I mean those motives of concern, whatever they are: financial, personal, religious, and so forth. Those experts who hammer people about immunization, they forget that people operate as much from the heart and the gut as they do the head. No one's a brainiac 100% of the time either. Fully rational decisionmaking has never been a marked human trait! So I find all the "preachifying" by experts to be a bit tiresome, and I think unproductive.
Immunization makes a certain keen sense when one considers it in the context of industrial medicine: moving lots of people into higher states of health, at least as health happens to be defined at the time. That too is a moving target. However, I can't say I entirely disagree with the premise of today's industrialized, mass medicine. It has a certain achievable efficiency.
Yet at the same time in political reality, that efficiency will reach some natural equilibrium with the crazy, mixed-up human spirit (and by this I mean mind, or consciousness, or perhaps something like a soul). Whatever it is, it's not predictable, and therefore no theory of human phenomena is entirely predictive. In short, no matter what a good idea some people think a thing is, not everyone will, and that will create a conflict.
So back to that PA's comment. I dug out the original journal article. Peter Doshi, of Johns Hopkins, wrote in British Medical Journal in 2013 that low vaccine effectiveness (it's been reported from 25-75% and varies year to year), overstatement of health risks, and poor study methodologies lead him to the conclusion that the annual influenza vaccination cycle is a marketing strategy without any clear benefit and uncertain costs. Doshi accomplishes this simply analyzing the CDC's own publications.
It's not that I didn't think that people weren't making money. It's not that I imagine that every nurse and every doctor that recommends a flu shot has mercenary motives, either. But it is those folks who mean well who I would urge to stop overstating the value of flu shots and the risks of the flu. If I had dollar for every person who I diagnosed with the flu who had their flu shot, I could buy a nice flight to Florida for the worst of the season.
I've seen a number of cases of the flu--or at least what appears to be the flu--this month. Clinically, the flu is marked by sore throat (usually), high fever (or high-ish, low 100s F), muscle aches, fatigue, and often a cough. However, like any bug, you need a lab test to be sure, and we hardly ever get those, unless lab facilities are close by and insurance is really good. There are innumerable respiratory viruses and many potential bacterial infections. The former must be treated with antivirals within about 2 days, and the latter often do but don't always respond to antibiotics (for example, whooping cough).
Anyway, I had no opportunity to culture anyone anyway. Helpful remedies have been Bryonia and Nux moschata--in the latter case especially sleepy flu cases! (And it is just a few cases.)
"Did you have your flu shot?" People might ask.
In general, I avoid vaccination for non-fatal diseases, and despite what some TV doctors say about it, the flu isn't usually fatal. You just feel like you want to die.
Why? Hmm, I have a sense that we need some sicknesses to maintain some ecological balance to our world. Sickle cell trait confers some protection against malaria. Cancers have been known to recede during periods of fever from infection. My sense is not entirely a random hunch.
A physician assistant writes in The Clinical Advisor, an online, sponsored medical magazine, that there are undisclosed financial relationships between flu committee members at the CDC and vaccine manufacturers. Further, he notes that dangers may be overstated (especially in terms of fatalities, which are low).
One might ask: is any fatality acceptable? A philosophical question, and unanswerable in a practical sense because people value different things. Much of what passes for the "vaccine controversey" is really a discussion about the value of the public good versus the value of the individual's good. This is a discussion--or just a cussin' out sometimes--between those who have set their needle for public good to a point which they believe is good and just, and those who set it a bit farther back. This becomes a very complex equation when you consider all the forces at work in someone. Multiply those "someones" and society's decisions become vexing indeed.
By "forces" I mean those motives of concern, whatever they are: financial, personal, religious, and so forth. Those experts who hammer people about immunization, they forget that people operate as much from the heart and the gut as they do the head. No one's a brainiac 100% of the time either. Fully rational decisionmaking has never been a marked human trait! So I find all the "preachifying" by experts to be a bit tiresome, and I think unproductive.
Immunization makes a certain keen sense when one considers it in the context of industrial medicine: moving lots of people into higher states of health, at least as health happens to be defined at the time. That too is a moving target. However, I can't say I entirely disagree with the premise of today's industrialized, mass medicine. It has a certain achievable efficiency.
Yet at the same time in political reality, that efficiency will reach some natural equilibrium with the crazy, mixed-up human spirit (and by this I mean mind, or consciousness, or perhaps something like a soul). Whatever it is, it's not predictable, and therefore no theory of human phenomena is entirely predictive. In short, no matter what a good idea some people think a thing is, not everyone will, and that will create a conflict.
So back to that PA's comment. I dug out the original journal article. Peter Doshi, of Johns Hopkins, wrote in British Medical Journal in 2013 that low vaccine effectiveness (it's been reported from 25-75% and varies year to year), overstatement of health risks, and poor study methodologies lead him to the conclusion that the annual influenza vaccination cycle is a marketing strategy without any clear benefit and uncertain costs. Doshi accomplishes this simply analyzing the CDC's own publications.
It's not that I didn't think that people weren't making money. It's not that I imagine that every nurse and every doctor that recommends a flu shot has mercenary motives, either. But it is those folks who mean well who I would urge to stop overstating the value of flu shots and the risks of the flu. If I had dollar for every person who I diagnosed with the flu who had their flu shot, I could buy a nice flight to Florida for the worst of the season.
Saturday, April 16, 2016
The Week in Infectious Diseases
This past week the Centers for Disease Control confirmed that Zika virus can cause microcephaly in those born to mothers infected with Zika. We don't know why it does so, but for now it causes us to consider several things:
This past week the Centers for Disease Control confirmed that Zika virus can cause microcephaly in those born to mothers infected with Zika. We don't know why it does so, but for now it causes us to consider several things:
- Those areas where the Aedes mosquito carries Zika--a lot of good vacation spots and the site of this summer's Olympics--are probably riskier places to go if you are a woman currently or planning to become pregnant. If your plans will take you to the American topics this year the CDC has a Travel Medicine section to assist with specific advice.
- It is too early to tell, but the warming Earth may lead to advance of the Aedes mosquito's range northward. Don't panic, but stay tuned. Expect that public health authorities will be monitoring for this in 2016. It reminds us of the importance of funding for public health and the importance of getting state budgets ready on time.
- Birth control and access to pregnancy termination vary a lot by country and politics. It will be interesting to see what happens in Latin American and Caribbean countries, many of which have strict laws against either or both practices. It is easy to think of these things in the abstract. When disease threatens, I wonder if it will cause women to become more politically active--especially in those countries. I wonder if the reality of Zika may cause some to think differently about medical technology and family planning.
- Nature is always at work, busy birds and bees...and viruses. Evolution can inspire fear, but it can also inspire change. It may be that the common good could require a lot more cooperation, both abroad and at home. Nurse researchers Meaona Kramer and Peggy Chinn observed that one way we know our world (and our world is the health business) is socio-politically. In short: one can't effectively divorce our health from our politics. In a society, we share diseases together, or we learn to stay healthy together.
...Including, the "Society" Inside Us
Late in 2015 Egija Zaura and her colleagues in Amsterdam reported that the human microbiome--the league of bacteria that live inside our guts--can be affected for up to a year after a single course of antibiotics. Ciprofloxacin ("Cipro") had the longest-lasting effect in this study. Ira Flatow of NPR's Science Friday frequently has stories about this microbiome, and what we are learning about it, how it affects everything from digestion to mood, immunity, and general health. Even short courses of antibiotics can lead to development of bacterial resistance.
Recently I was updating material for a course I teach and had to update my array of "superbugs" that have emerged in the last year. Mostly, these won't immediately affect the average person. Hospitalized persons are most at risk (which doesn't make us feel great about being in the hospital!), although I've been seeing more methicillin-resistant Staph infections in the office in the last few years.
I will use antibiotics if necessary, but many times antibiotics aren't needed. Now we have even better reasons to use caution with these drugs that seem so harmless otherwise. Fortunately, herbalism, homeopathy, and nutrition can be used to help the body back to health and also relieve some symptoms. So far these things have not shown any negative interactions with the gut, but it's an area where a lot more research could be done.
Full citation: from McGraw, M. citing Zaura E, Brandt B, et al. Same Exposure but Two Radically Different
Responses to Antibiotics: Resilience of the Salivary Microbiome versus
Long-Term Microbial Shifts in Feces. mBio. 2015.
Saturday, April 9, 2016
Social Response to Lyme...and things like it
Do new diseases emerge?
Fibromyalgia, chronic Candida, variations on Lyme disease, chronic fatigue syndrome, etc. These are all examples of modern disease about which there is controversy. Doctors don't agree on the existence of these conditions, much less on their treatment. The scientific literature hasn't categorized these things very well. The accepted diseases all fit into a category of "known" because they fit the existing model of disease.
In fact, even these labels themselves reflect that way of thinking, that is, that "diseases" fit into a way of thinking about diseases (regardless of what patients think or feel).
We are all very indoctrinated into thinking of disease as discreet things that can be neatly categorized with a label. In regular medicine, those labels all fit into a few categories.
Sufferers of such "dis-eases" often also suffer the disbelief of doctors in mainstream medicine. To be fair, most physicians are materialists. This is the model they know. It is a good model for many things. It has its limits.
So in step the specialists--mainstream and alternative--to try to sort things out and bring relief. There's a belief by many that these are "first world problems". That is, they are only problems because we have the appropriate conditions for them to emerge (wealth, ease, too much food, etc.). But that's a short-sighted way of looking at things. There's also a belief that these problems can respond to regular medicine, imaginatively-reinvented. In some cases I have observed that to be true. These things are being researched, in some cases, and may become part of the canon of medicine.
Probiotics during antibiotic treatment. Well researched, and consensus-approved, it nevertheless remains an underutilized preventative. So, even when something's accepted, it may take years to become a real part of every doctor's world view.
Then, there are the skeptics. I'm not sure what skeptics stand to gain from treating these maladies like some sort of aberration, or psychiatric cases, or malingering. If people feel sick they feel sick. The question is why.
Society also tends to take cues from the doctors and the skeptics. As such, some with "chronic Lyme" may be viewed as crazy or just lazy.
This is why so many people who claim to suffer from such diseases seek alternatives. And because of the we are all taught to characterize "disease" these folks label themselves! For the classical homeopath, these labels aren't very important, except maybe to gauge what the expected trajectory will be, and perhaps to give the patient a bill with an acceptable label so that insurance might reimburse the person. For the homeopath, it's more important to know the pattern of symptoms, regardless of the cause.
So in summary, society's response to chronic Lyme (or any of these other emergent diseases) isn't to wonder if nature is evolving (it is), rather it's to fall back to commonplace, materialistic explanations, and when those don't fit, to label the person as "anxious" or "crazy" or "attention-seeking." It is logical to imagine that as our world, evolves, so does disease. In that sense it seems rather arrogant for doctors to not be at least curious about what their patients present with.
But, if you don't have a way to view the problem, then won't have the tools to fix it. That leaves doctors stuck, and being stuck really makes doctors uncomfortable.
Do new diseases emerge?
Fibromyalgia, chronic Candida, variations on Lyme disease, chronic fatigue syndrome, etc. These are all examples of modern disease about which there is controversy. Doctors don't agree on the existence of these conditions, much less on their treatment. The scientific literature hasn't categorized these things very well. The accepted diseases all fit into a category of "known" because they fit the existing model of disease.
In fact, even these labels themselves reflect that way of thinking, that is, that "diseases" fit into a way of thinking about diseases (regardless of what patients think or feel).
We are all very indoctrinated into thinking of disease as discreet things that can be neatly categorized with a label. In regular medicine, those labels all fit into a few categories.
- A pathology. This means that there are tissues changes that always fit a certain pattern. Cancer is a good example. A pathologist examines the tissue changes found in the tumor, and voilá you have an actual disease!
- A change in physiology. This means the chemical processes are changed. A good example is adult-onset diabetes. Ultimately, a tissue pathology will probably be found. The chemical features of such a disease are usually well-described (in diabetes? an inability to properly process sugars).
- A germ-caused disease. This is when a germ--a virus or bacteria or whatever--causes changes (sickness, really) that follows a set of known patterns. Good examples today include influenza, Ebola virus infection, and so on. ("Chronic Candida infection doesn't fit this category. Neither does late-stage Lyme).
- A gene disease. This is when there's a known gene defect that leads to physiological changes or changes in tissues. An example would be Down syndrome,and other well-known genetic conditions.
Pretty much everything in the International Classification of Diseases, 10th Edition, fits into one of those categories. The causes vary. Trauma can cause tissue damage, for example. Category 1. Get the idea?
Interestingly, mental health diseases aren't really known to fit any such category. Even today, most mental health problems like depression or anxiety are mysteries.
What about these diseases about which doctors don't agree?
Sufferers of such "dis-eases" often also suffer the disbelief of doctors in mainstream medicine. To be fair, most physicians are materialists. This is the model they know. It is a good model for many things. It has its limits.
So in step the specialists--mainstream and alternative--to try to sort things out and bring relief. There's a belief by many that these are "first world problems". That is, they are only problems because we have the appropriate conditions for them to emerge (wealth, ease, too much food, etc.). But that's a short-sighted way of looking at things. There's also a belief that these problems can respond to regular medicine, imaginatively-reinvented. In some cases I have observed that to be true. These things are being researched, in some cases, and may become part of the canon of medicine.
Probiotics during antibiotic treatment. Well researched, and consensus-approved, it nevertheless remains an underutilized preventative. So, even when something's accepted, it may take years to become a real part of every doctor's world view.
Then, there are the skeptics. I'm not sure what skeptics stand to gain from treating these maladies like some sort of aberration, or psychiatric cases, or malingering. If people feel sick they feel sick. The question is why.
Society also tends to take cues from the doctors and the skeptics. As such, some with "chronic Lyme" may be viewed as crazy or just lazy.
This is why so many people who claim to suffer from such diseases seek alternatives. And because of the we are all taught to characterize "disease" these folks label themselves! For the classical homeopath, these labels aren't very important, except maybe to gauge what the expected trajectory will be, and perhaps to give the patient a bill with an acceptable label so that insurance might reimburse the person. For the homeopath, it's more important to know the pattern of symptoms, regardless of the cause.
So in summary, society's response to chronic Lyme (or any of these other emergent diseases) isn't to wonder if nature is evolving (it is), rather it's to fall back to commonplace, materialistic explanations, and when those don't fit, to label the person as "anxious" or "crazy" or "attention-seeking." It is logical to imagine that as our world, evolves, so does disease. In that sense it seems rather arrogant for doctors to not be at least curious about what their patients present with.
But, if you don't have a way to view the problem, then won't have the tools to fix it. That leaves doctors stuck, and being stuck really makes doctors uncomfortable.
Thursday, March 31, 2016
Zika Update
The Centers for Disease Control have issued a couple of updates on the Zika virus. The first concerns travel to Zika-infested areas, and a study finds that the mosquito that spreads the virus, Aedes egypti, is not active at higher elevations. Researchers mapped new cases and found that they occur at elevations below 2000 meters (about 6,500 feet). If your travel plans take you to higher elevations in Zika-affected countries in the tropics, your risk of Zika is low to non-existent. Extraordinary mosquito protections are not necessary because the cooler, drier climate of mountainous zones. In a second report, the CDC has approved a test to screen blood donations. This will be of great help in countries affected by the virus, because it will improve the safety of blood transfusion. The virus does linger a bit after the infection clears. In a related notice, the CDC recommends that pregnancy be delayed for about 2 months after travel to Zika-affected areas. However, the real connection of the virus to microcephaly (small infant head with mental defects) remains elusive.
The Centers for Disease Control have issued a couple of updates on the Zika virus. The first concerns travel to Zika-infested areas, and a study finds that the mosquito that spreads the virus, Aedes egypti, is not active at higher elevations. Researchers mapped new cases and found that they occur at elevations below 2000 meters (about 6,500 feet). If your travel plans take you to higher elevations in Zika-affected countries in the tropics, your risk of Zika is low to non-existent. Extraordinary mosquito protections are not necessary because the cooler, drier climate of mountainous zones. In a second report, the CDC has approved a test to screen blood donations. This will be of great help in countries affected by the virus, because it will improve the safety of blood transfusion. The virus does linger a bit after the infection clears. In a related notice, the CDC recommends that pregnancy be delayed for about 2 months after travel to Zika-affected areas. However, the real connection of the virus to microcephaly (small infant head with mental defects) remains elusive.
Sunday, March 27, 2016
Our Response to Lyme: Medical
When Lyme first appeared in the latter half of the 20th century, we treated it with antibiotics, and that was that. Late-stage cases did occur, and we figured that out, and then we treated that antibiotics too. But not everyone got better--at least right away. These were cases that people started calling "chronic Lyme disease."
Like a lot of chronic diseases that medicine doesn't seem to quite have a handle on, the world of Lyme disease sufferers developed a parallel medical world full of "Lyme doctors" who prescribe immense doses of oral and intravenous antibiotics, alternative practitioners advocating various protocols using herbs, nutritionals, multiple homeopathic remedies, and other methods. I hear reports from people that suggest that sometimes these work for some people. But as I tell my students: Every modality has cured every disease--at least once. Meaning: just because it worked once for someone else doesn't mean you can rely on it to cure you. That's one of the weird things about human biology and medicine.
So the trick is to figure out what modality is going to work most of the time.
So far, I've only found a few modalities that will. Traditional Chinese medicine (TCM) and classical homeopathic medicine are two general systems that work. Dr. Andrew Weil, the physician and writer about all things alternative, notes in his book Health and Healing that there are only a few methods of medicine that are broad and systematic enough to serve as true alternatives to traditional Western medicine. TCM and classical homeopathy are two of the few. Most other modalities are more complementary to the healing process. Some modalities, like Western medicine and naturopathic medicine, are broad, but they don't have a coherent theory to provide the systematic structure of diagnosis and treatment that could more reliably address conditions that are not so straightforward.
Post-Lyme treatment syndrome (PLTS) is one such condition.
PLTS is believed to be caused not by lingering B. burgdorferi infection, and not by so-called co-infections with Babesia and other related germs. Rather it is believed to be a perverted immune system reaction to the infection in the first place. In this way, the symptoms of PLTS are really a crazy immune system reaction. We see parallels in syphilis, HIV, and even type 1 diabetes, multiple sclerosis, and Guillain-Barré syndrome--in these latter three cases, the diseases seem to emerge after even a simple viral infection causes the immune system to attack the body's own pancreatic cells and nerve cells, respectively.
Our response to these types of problems, using Western medicine and many alternative approaches, is to try to cobble together a treatment that fits within our rudimentary understanding of things. An example would be trying ever-increasing doses of antibiotics, over ever-longer durations of treatment, despite known side effects of such medications. Another example in the alternative world could include various supplements. Often I have observed such patients to be on literally dozens of supplements! That just can't be good for a person's health (and it's not good for their wallet either).
Both classical homeopathy and TCM begin with the assumption that one doesn't need to know what specific features are malfunctioning, deficient, or excessive, so much as they rely on understanding the pattern of these features that are made visible to the practitioner through the pattern of the patient's symptoms. In this way, we recognize that each person's "imbalance" is unique, and simply fits into a pattern that we already know. Find the pattern, find the cure.
It's not that some nutritional supplementation, exercise, or even medical drugs aren't needed ever in such cases. It does mean that one ought to view the system--the person--as a whole that is responding in every cell of his or her body to the imbalance imposed by the accident of the infection, and that each person's reaction can fall into one of hundreds of patterns of imbalance.
Next: Our response to Lyme (and things like it), as a society.
When Lyme first appeared in the latter half of the 20th century, we treated it with antibiotics, and that was that. Late-stage cases did occur, and we figured that out, and then we treated that antibiotics too. But not everyone got better--at least right away. These were cases that people started calling "chronic Lyme disease."
Like a lot of chronic diseases that medicine doesn't seem to quite have a handle on, the world of Lyme disease sufferers developed a parallel medical world full of "Lyme doctors" who prescribe immense doses of oral and intravenous antibiotics, alternative practitioners advocating various protocols using herbs, nutritionals, multiple homeopathic remedies, and other methods. I hear reports from people that suggest that sometimes these work for some people. But as I tell my students: Every modality has cured every disease--at least once. Meaning: just because it worked once for someone else doesn't mean you can rely on it to cure you. That's one of the weird things about human biology and medicine.
So the trick is to figure out what modality is going to work most of the time.
So far, I've only found a few modalities that will. Traditional Chinese medicine (TCM) and classical homeopathic medicine are two general systems that work. Dr. Andrew Weil, the physician and writer about all things alternative, notes in his book Health and Healing that there are only a few methods of medicine that are broad and systematic enough to serve as true alternatives to traditional Western medicine. TCM and classical homeopathy are two of the few. Most other modalities are more complementary to the healing process. Some modalities, like Western medicine and naturopathic medicine, are broad, but they don't have a coherent theory to provide the systematic structure of diagnosis and treatment that could more reliably address conditions that are not so straightforward.
Post-Lyme treatment syndrome (PLTS) is one such condition.
PLTS is believed to be caused not by lingering B. burgdorferi infection, and not by so-called co-infections with Babesia and other related germs. Rather it is believed to be a perverted immune system reaction to the infection in the first place. In this way, the symptoms of PLTS are really a crazy immune system reaction. We see parallels in syphilis, HIV, and even type 1 diabetes, multiple sclerosis, and Guillain-Barré syndrome--in these latter three cases, the diseases seem to emerge after even a simple viral infection causes the immune system to attack the body's own pancreatic cells and nerve cells, respectively.
Our response to these types of problems, using Western medicine and many alternative approaches, is to try to cobble together a treatment that fits within our rudimentary understanding of things. An example would be trying ever-increasing doses of antibiotics, over ever-longer durations of treatment, despite known side effects of such medications. Another example in the alternative world could include various supplements. Often I have observed such patients to be on literally dozens of supplements! That just can't be good for a person's health (and it's not good for their wallet either).
Both classical homeopathy and TCM begin with the assumption that one doesn't need to know what specific features are malfunctioning, deficient, or excessive, so much as they rely on understanding the pattern of these features that are made visible to the practitioner through the pattern of the patient's symptoms. In this way, we recognize that each person's "imbalance" is unique, and simply fits into a pattern that we already know. Find the pattern, find the cure.
It's not that some nutritional supplementation, exercise, or even medical drugs aren't needed ever in such cases. It does mean that one ought to view the system--the person--as a whole that is responding in every cell of his or her body to the imbalance imposed by the accident of the infection, and that each person's reaction can fall into one of hundreds of patterns of imbalance.
Next: Our response to Lyme (and things like it), as a society.
Monday, March 21, 2016
Spring has Sprung...and so has Lyme Disease
I have a student this semester who is working on her senior project. The subject is Lyme disease. Part of the assignment is to study community resources that are available for people who suffer from the health problem the student is investigating. As one can see from the map, Lyme is a common concern here in the northeast, although it does occur everywhere.
My student has been exploring the world of medicine that operates behind
the scenes of what we commonly think of as "medicine" and medical
practice.Just Google "Lyme Disease" and you'll get a lot of hits. Many are mainstream pages, like WebMD, the Centers for Disease Control, and Mayo Clinic. But there are also dozens of alternative sites such as My Chronic Lyme Disease Journey, Lymeinfo, and many discussion boards in which sufferers, clinicians, and healers talk about the condition and its effects and its cure. I recently read my student's midterm journal report, and indeed she has found herself deep in the middle of this complicated, confusing world. I think it must be even more strange for professionals, like my student, an RN getting advanced degree, who are used to living in the world of "legitimate" medicine, a world run by doctors and hospitals, a world with an accepted view of biomedicine, a world that tends to marginalize those who advocate alternative viewpoints.
Two Stories of Lyme
The first story has to do with what Lyme disease is and what it does. The second story is about our response to Lyme. My student's experience this semester touches on both.
What Lyme Is and Does
For a long time we thought that Lyme, like other bacterial diseases, would respond simply to antibiotic treatment. That is, you get bitten by a deer tick. You get the rash, maybe a fever or some joint pains. We give you doxycycline or something, and you get better. However, Lyme, like syphilis, comes from a family of bacteria that tend to stick around. Like syphilis, there are "tertiary" or late-stage Lyme cases. Any disease can be beaten by the human immune system, but there are some against which the immune system doesn't always do so well. Examples include syphilis, Lyme, HIV, hepatitis C, hepatitis B, and others. Yes, there are cases in which all of the foregoing diseases have been cleared or cured by the genetics and immunity of certain individuals (how about that!)--but in general, this group of infections requires a bit of help from antibiotics or antivirals.
So Lyme--Borrelia burgdorferi--is a little corkscrew shaped bug that gets into a variety of tissues, especially joints, and if untreated and uncleared by a person's immune system, becomes a source of chronic, low level inflammation, which can eventually cause really serious problems: arthritis, weakness, brain fog, and even heart problems. The treatment for every stage of Lyme is antibiotics, usually a course lasting anywhere from 10 days to 4 weeks, depending on the duration, and on which authority's recommendations are used. Late-stage Lyme can last decades to a lifetime.
Next installment: Our Response to Lyme
I have a student this semester who is working on her senior project. The subject is Lyme disease. Part of the assignment is to study community resources that are available for people who suffer from the health problem the student is investigating. As one can see from the map, Lyme is a common concern here in the northeast, although it does occur everywhere.
 |
| Lyme Disease in Northeast U.S. (Courtesy CDC 2014) |
Two Stories of Lyme
The first story has to do with what Lyme disease is and what it does. The second story is about our response to Lyme. My student's experience this semester touches on both.
What Lyme Is and Does
For a long time we thought that Lyme, like other bacterial diseases, would respond simply to antibiotic treatment. That is, you get bitten by a deer tick. You get the rash, maybe a fever or some joint pains. We give you doxycycline or something, and you get better. However, Lyme, like syphilis, comes from a family of bacteria that tend to stick around. Like syphilis, there are "tertiary" or late-stage Lyme cases. Any disease can be beaten by the human immune system, but there are some against which the immune system doesn't always do so well. Examples include syphilis, Lyme, HIV, hepatitis C, hepatitis B, and others. Yes, there are cases in which all of the foregoing diseases have been cleared or cured by the genetics and immunity of certain individuals (how about that!)--but in general, this group of infections requires a bit of help from antibiotics or antivirals.
So Lyme--Borrelia burgdorferi--is a little corkscrew shaped bug that gets into a variety of tissues, especially joints, and if untreated and uncleared by a person's immune system, becomes a source of chronic, low level inflammation, which can eventually cause really serious problems: arthritis, weakness, brain fog, and even heart problems. The treatment for every stage of Lyme is antibiotics, usually a course lasting anywhere from 10 days to 4 weeks, depending on the duration, and on which authority's recommendations are used. Late-stage Lyme can last decades to a lifetime.
Next installment: Our Response to Lyme
Saturday, March 12, 2016
Materialist Science as a Model Obsolescence
I'm reading Richard Dawkins' 1976 classic The Selfish Gene. In that era, Darwin's theory of evolution was 117 years old. On The Origin of Species marked a revolution in our understanding of the fundamentals of biology, how life organized and developed over eons. Of course, a molecular description of genetics would require another century to fully mature (Watson and Crick's modeling of DNA), but between Greek and Roman notions of heritage, Gregor Mendel's experiments in plant inheritance, and Darwin's theory of selection, we got a lot worked out. There were competing theories of speciation and inheritance, but in the end one model explained things better than the others.
As I proceeded in my reading, I found myself reading related material, you know, looking things up and cross examining Dawkins' work. In his Wikipedia article I learned that Dawkins' is an ethologist--someone who studies animal behavior under natural conditions--and is an outgrowth of the scientific orientation of naturalists like Darwin. I won't go into Dawkins' thesis in detail here, since I'm mostly interested in this particular book in terms of its historical significance. Simply put, he argued for the primacy of the material of inheritance as the driver of evolutionary success. That is: Genes are (most of our) destiny. The "selfish" bit? He admits that he felt it made a punchy title that gets across his argument that genes are themselves the basic unit of evolutionary success and that such success is "self-ish", and he didn't mean this in a teleological way.
I actually don't find this notion in conflict with my own views of biology (mostly).
As I looked up one thing after another during my reading of Selfish and came across Rupert Sheldrake, who happens to be close in age to Dawkins', and a link to whose work you'll find in my webpage under "My Influences".
This made for fun reading, since Sheldrake is considered by some (like the authors of his Wikipedia article) to specialize in "the paranormal" although Dr. Sheldrake seems content to consider himself a biologist. I say fun, because the authors of that article don't assign Sheldrake to "nonsense" and only a little bit to "pseudoscience" (unlike the Homeopathy entry, which is heartily given both labels). It was fun because one gets a glimpse of the controversy surrounding the work of Sheldrake, the back and forth between the Materialists and the New Vitalists.
Vitalism is a very old notion in biology and in medicine in particular. It's the notion that we are more than just material. Clerics and mystics called this The Soul. But others had various names for it, and the idea of vitalism doesn't depend on religion for its proposed existence. Vitalism is a key piece of homeopathy: without it, homeopathy doesn't exist. Vitalism also fits into a host of other medical systems and techniques such as acupuncture, faith healing, Ayurveda, healing touch and others. To keep it simple, think of vitalism as describing a kind if energy. In Chinese medicine, for example, it is called "qi"(chi).
So vitalism kind of died out in the 20th century. Materialist explanations were just too successful as our methods and instrumentation became more and more powerful. Examples include advanced experimental methodologies, statistics, electron microscopes, functional MRI, and so on.
However, all of this was still within the scope of Thomas Kuhn's "normal science", that realm of socially acceptable scientific investigation and natural philosophy that forms the box we're all supposed to remain within. It is a model that is essentially "materialist", meaning that phenomena can be explained through the agency of material acting on other material. Put another way, it means that the universe can be explained exclusively through a model that relies on atomic and chemical reactions, and known energies, such as electromagnetic energy, gravity, and radioactivity.
I mentioned functional MRI earlier. Today it's a technology that is used to explore brain function in neuroscience. Results from such study have been interpreted to mean that all consciousness arises from the brain, and that volition--origination of thought, free will--may be illusory. The late neuropsychologist Klaus Grawe wrote that a thought arises before we are aware we have thought it. More pointedly: we believe we think of things but in reality our brain generates thoughts and we believe we originated those thoughts. Having a thought precedes being able to will it.
If that's really the case, then there is no free will--all thought is kind of predestined. Alternatively, we're mostly pretty random beings, stuck in our behaviors, which seem to arise willy-nilly from our neurons. Admittedly, this model would explain a lot of things about people, but it does mean that our self-awareness is an illusion, our will is not our will at all. It's connected to something, but not to our intention.
And here's a bit: it's a materialist view of nature. It fits very well into normal science, although it seems rather bleak. To be fair, Grawe's book, Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy, was certainly an effort to bring hope to people suffering from mental health problems! Still, it seems rather bleak that we have no essential will and that everything still devolves to the "substance".
So, back to Dawkins and Sheldrake. Dawkins and others subscribe to a logical positivist view of the world which argues that there is a single, objective reality, and that reality is materialistic (which includes the known, currently measurable energies I summarized above). Sheldrake and others--and I include myself here--argue that too many loose ends have accumulated. These loose ends are not described by the current model. Sheldrake's "morphogenic field" gives form to organisms, and subtly influences phenotype. Homeopathy, I argue, is a "weak" medicine, but one that gets at a subtle and as-yet-unmeasured field that helps to regulate living organisms. However, like judo, a small effort in just the right way can have large effects.
The late Martha Rogers was a nurse-theorist who proposed that humans are energy beings, that our material selves are temporary manifestations of our selves, and that death itself is a passage to a higher "vibrational" state. In graduate school, I reviewed the experimental evidence for her theory and found it wanting. To some this solidifies the materialist view. I would argue that it simply means that Rogers' theory is not accurate in its present form. Loose ends pile up in the box of normal science. Those loose ends call for alternative ways of explaining our world. The hypotheses that attempt to explain them are many: subtle energies, psi energy, morphogenic fields, and so on. Natural experiments abound: Reiki, homeopathy, acupuncture, and many people exploring "paranormal" phenomena like extrasensory perception, out of body travel, and so on.
Why this seems to make the Materialists angry is a matter I will attempt in my next installment.
Monday, February 29, 2016
Tales of the Profession, part 1
So I just finished reading the evaluation comments from an educational speech I gave back in April. Most of the comments reflected a general pleasure at an opportunity to learn more about a strange and complicated therapy that clinicians don't really get to learn about much (homeopathy). Of course there are always a few folks one can't reach--that always challenges me to consider improvements to my teaching methods.
Today I'm focused on a few specific comments that concern me, and they should perhaps concern you too.
Let me provide some background. The talk was a one hour presentation about homeopathic medicine to a group of medical providers, mostly nurse practitioners and physician assistants, some nurses and a handful of physicians. One hour. What does one talk about? There are several possibilities. One could focus on the science, such as clinical trials, or studies that summarize many trials. I could address specific criticisms of homeopathy, like the highly diluted remedies or the method of remedy selection itself. But I think that would put the cart before the horse--after all, if one doesn't even know the basics, how would one understand the criticisms? The science would seem out of context.
I could teach the historical development of homeopathy, and that could include the "how" of homeopathy, how it works in practice. But this was a talk to clinicians, and not merely a history lesson. These people want to know how to begin to use it. When I first started out, I used simple, low potency, over-the-counter remedies for self-limiting conditions like colds and bee stings. It's how a lot of professional homeopaths begin their interest in the art.
So I decided to disclaim the science up front, and the history. That is, why not just tell folks that this is how it's done and the history and maybe a little bit of the scientific proof could be included, but I only had an hour so I'd focus on the nuts and bolts. "Try this at home!"
So, back to the comments.
Several people--and these were a minority--worried over the scientific rigor. "Where are the studies?! " Others seemed concerned with things unrelated to homeopathic medicine, such as the interactions between St. John's wort and medicines. (I was careful from the start to explain the difference between homeopathic medicine and herbal medicine, since these are often confused, even by professions who ought to know better these days!) Another: "He did not present any proof homeopathic medications work..." which is true. As I noted, I had an hour. I chose to focus on the open minds.
But wait! Isn't scientific proof important? In the 1980s the New England Journal of Medicine reported that perhaps 85% of medical practices were unsupported by any evidence. This created the "Evidence Based Practice" revolution. EBP has since spread and become the dominant force in medical practice, which is mostly a good thing. Unfortunately it's also created a rigidity of thinking, a prejudice, that closes minds to thinking outside the box. How can one listen with an open mind and an open heart if there's a requirement for a list of double-blind placebo controlled trials first? If I'd had all day, I could have provided that kind of structure, or assigned readings ahead of time. But...you work with what you have. What concerns me is that these are people who might be closing their minds to possibilities, and to the customs and habits of their patients. Instead of listening and learning, they just frown.
(By the way, a ton of medicine is still not based on clinical trials. Much is still based on expert opinion, consensus statements, and the like.)
I have learned so much from my patients, and some of the stuff they have tried that "cured" or helped them I have to admit sounds pretty weird. But medicine is weird. Humans don't read the studies and they don't follow the textbooks. Science moves ahead in small steps, and no matter how detailed it gets it'll never cover every imaginable situation in real life.
What makes me feel good about that talk and the audience comments is that a lot of the folks who attended took it for what it was: a chance to learn a little bit about a big subject in a short time. Those people aren't stupid; they will have more questions about the science and applications of homeopathy. Some might even be willing to "play around with it" safely, like I did when I was learning. Or if it seemed unappealing, well at least they understand more about what their patients might be doing!
What makes me feel bad about it is that there still people out there, practicing medicine, whose minds are still locked in a model of medical prejudice that calls Science its god. But it isn't a god. It's a method, and it worries me that there are still so many people who apply that method in a limited way.
People say they "believe in science." That's rubbish. Saying one believes in science is like saying one believes in wrenches. Both are tools. Science is a philosophical tool that enables us to probe the limits of knowledge. If one really believes in the utility of the tool, then one should profess to keep an open mind. That doesn't mean "anything goes", that we can just make up "facts" or believe in facts we like. It means we recognize the limits of our knowledge, and understand how influenced we are by our culture and by commerce. Big corporations have bought a lot of "science"; that doesn't make it good science. Just because a phenomenon cannot be easily explained doesn't mean it's wrong or without merit.
So I just finished reading the evaluation comments from an educational speech I gave back in April. Most of the comments reflected a general pleasure at an opportunity to learn more about a strange and complicated therapy that clinicians don't really get to learn about much (homeopathy). Of course there are always a few folks one can't reach--that always challenges me to consider improvements to my teaching methods.
Today I'm focused on a few specific comments that concern me, and they should perhaps concern you too.
Let me provide some background. The talk was a one hour presentation about homeopathic medicine to a group of medical providers, mostly nurse practitioners and physician assistants, some nurses and a handful of physicians. One hour. What does one talk about? There are several possibilities. One could focus on the science, such as clinical trials, or studies that summarize many trials. I could address specific criticisms of homeopathy, like the highly diluted remedies or the method of remedy selection itself. But I think that would put the cart before the horse--after all, if one doesn't even know the basics, how would one understand the criticisms? The science would seem out of context.
I could teach the historical development of homeopathy, and that could include the "how" of homeopathy, how it works in practice. But this was a talk to clinicians, and not merely a history lesson. These people want to know how to begin to use it. When I first started out, I used simple, low potency, over-the-counter remedies for self-limiting conditions like colds and bee stings. It's how a lot of professional homeopaths begin their interest in the art.
So I decided to disclaim the science up front, and the history. That is, why not just tell folks that this is how it's done and the history and maybe a little bit of the scientific proof could be included, but I only had an hour so I'd focus on the nuts and bolts. "Try this at home!"
So, back to the comments.
Several people--and these were a minority--worried over the scientific rigor. "Where are the studies?! " Others seemed concerned with things unrelated to homeopathic medicine, such as the interactions between St. John's wort and medicines. (I was careful from the start to explain the difference between homeopathic medicine and herbal medicine, since these are often confused, even by professions who ought to know better these days!) Another: "He did not present any proof homeopathic medications work..." which is true. As I noted, I had an hour. I chose to focus on the open minds.
But wait! Isn't scientific proof important? In the 1980s the New England Journal of Medicine reported that perhaps 85% of medical practices were unsupported by any evidence. This created the "Evidence Based Practice" revolution. EBP has since spread and become the dominant force in medical practice, which is mostly a good thing. Unfortunately it's also created a rigidity of thinking, a prejudice, that closes minds to thinking outside the box. How can one listen with an open mind and an open heart if there's a requirement for a list of double-blind placebo controlled trials first? If I'd had all day, I could have provided that kind of structure, or assigned readings ahead of time. But...you work with what you have. What concerns me is that these are people who might be closing their minds to possibilities, and to the customs and habits of their patients. Instead of listening and learning, they just frown.
(By the way, a ton of medicine is still not based on clinical trials. Much is still based on expert opinion, consensus statements, and the like.)
I have learned so much from my patients, and some of the stuff they have tried that "cured" or helped them I have to admit sounds pretty weird. But medicine is weird. Humans don't read the studies and they don't follow the textbooks. Science moves ahead in small steps, and no matter how detailed it gets it'll never cover every imaginable situation in real life.
What makes me feel good about that talk and the audience comments is that a lot of the folks who attended took it for what it was: a chance to learn a little bit about a big subject in a short time. Those people aren't stupid; they will have more questions about the science and applications of homeopathy. Some might even be willing to "play around with it" safely, like I did when I was learning. Or if it seemed unappealing, well at least they understand more about what their patients might be doing!
What makes me feel bad about it is that there still people out there, practicing medicine, whose minds are still locked in a model of medical prejudice that calls Science its god. But it isn't a god. It's a method, and it worries me that there are still so many people who apply that method in a limited way.
People say they "believe in science." That's rubbish. Saying one believes in science is like saying one believes in wrenches. Both are tools. Science is a philosophical tool that enables us to probe the limits of knowledge. If one really believes in the utility of the tool, then one should profess to keep an open mind. That doesn't mean "anything goes", that we can just make up "facts" or believe in facts we like. It means we recognize the limits of our knowledge, and understand how influenced we are by our culture and by commerce. Big corporations have bought a lot of "science"; that doesn't make it good science. Just because a phenomenon cannot be easily explained doesn't mean it's wrong or without merit.
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