(November is going to be Complementary and Alternative Medicine month here on Panda Bear, MD. My recent posts on the subject have generated a lot of interest, quite a few visits, and a bunch of angry email so I believe there is some interest in the subject out there. I apologize to you, oh my long-suffering readers, who would like to read more about residency and medical school but as I have categorized all of my previous articles on that subject and I have recently thrown you plenty of red meat on the subject of Emergency Medicine I ask for your indulgence as we explore the inroads of the lunatic fringe into the medical profession.-PB)

If Wishes and Buts Were Candies and Nuts We’d All Have a Merry Christmas

No one thinks rationally anymore, not even the well-educated. While I don’t necessarily expect critical thinking from the unwashed, higher education, while of no practical value to the legions of college graduates sporting their polyurethane diplomas, should at least teach people to think critically or there is no point to it and it becomes just a four year interlude where you learned a bunch of trivia and borrowed a lot of money to party with sorority girls. Certainly you should ask for your money back if you graduated without the intellectual skill to distinguish something that you want to be true from something that is. And you should ask for a refund if you have been awarded a diploma in any field without obtaining the fund of knowledge to recognize the difference between something that could be possible and something that can’t possibly be.

Take Homeopathy, a medical therapy which relies on the imaginary property of water to retain the memory of a substance which it has diluted to a point where not a single atom of the substance remains. People often ask me if my experience with Emergency Medicine, the most practical and hard-nosed of the medical specialties, has left me cynical about the possibility of finding some validity in Homeopathy and other equally ridiculous Complementary and Alternative Medicine therapies. Actually, by the time I had finished the eighth grade I had a sufficient background in chemistry and biology to recognize that these things cannot possibly work. How much education do you need, for example, to definitively state that spinal manipulation cannot possibly obviate the need for vaccinations (as many of our chiropractic friends believe) or that spiritual fire cannot possibly, a la Saturday morning cartoons, stream out of the fingers of Reiki healers? It’s not even as if we’re arguing some subtle point about the energy state of an electron shell or an obscure ion channel in yer’ fucking spleen. This is literally third grade stuff and the fact that many prestigious medical centers lack the institutional courage to point it out should make you cringe in shame, either at their gullibility or their venality.

“Well, we’re just being open-minded,” is the formula used to justify spending large sums of money to investigate therapies that even my ten-year-old son could instantly recognize as not only impossible but also somewhat ridiculous. I guess I’ll just have to be closed-minded because if you asked me for money to investigate the healing properties of magical gnomes I would turn you down. Gnomes, like Reiki, Homeopathy, faith healing, and ayurvedic medicine are ridiculous at face value. The extent that they are investigated highlights one of the biggest problems with Complementary and Alternative Medicine, not that it is mostly ridiculous (which it is), takes money from the gullible including those who really can’t afford it (which it does), or even that it sometimes delays the effective treatment of health problems (which I see regularly), but that it has the potential at a time when we should be looking for ways to economize on medical care to suck up even more public money with nothing to show in return except the enrichment of a pack of charlatans.

As many of my regular readers know I have a deep skepticism for much of what we do even in the practice of real medicine and believe we waste vast sums on only marginally effective and oftentimes inopportune therapies. It is not unusual in our system, for example, for a nonagenarian patient teetering on the edge of death to be followed by six specialists as well as a primary physican, have undergone batteries of repetitive tests and redundant imaging studies, and been the recipient of scores of procedures, many of them of dubious benefit as it relates to decreasing their morbidity or mortality.  There is also no question that cognitive medicine, the art of deliberating and arriving at the optimal and usually the simplest treatment regimen for a patient, is playing second fiddle to procedural medicine. I confess that I sometimes fantasize about being a primary care physician if only so I could sit down with my masively polypharmic and polyiatric patients to make sense of everything being done to them, much of it harmful or of only limited use.

No need to make the problem worse by invoking qi, karma, and magic pixies as therapies except if you believe that everyone should have an equal opportunity to steal money from the public.  In other words, the answer to the oft-cited rational for patients turning to CAM, that they have exhausted all that real medicine can offer, is not to keep feeding their delusions that they’ll live forever or can achieve health without effort but to have the economic courage to tell them that nothing more needs or can be done and that medicine cannot solve most of their problems. In other words, we need to continue to make medicine as rational as we possibly can, eschewing treatments and practices that are ineffective or ridiculous despite what the public wants. More importantly, medicine shoud be a minimalistic pursuit where we have the common sense to limit what we do instead of continuing to expand our scope so that everything under the sun, including the great spiritual void in the hearts of those who dabble in Complementary and Alternative Medicine, becomes a medical problem.

The desire to spread the tentacles of Complementary and Alternative Medicine to real patients, those who have real diseases and not nebulous emotional complaints, has the potential to suck even more money into health care, money that is going to be thrown away as surely as we throw it away keeping the living dead warm in the ICU.

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