Wednesday, August 15, 2007

More About Complementary Alternative Medicine

I’ve been stewing on this for several weeks as many of my favorite medblogs go on the offensive with respect to complementary alternative medicine – CAM. I’ve taken the opportunity to comment on these various blogs as a way of opening up a dialog so docs can hear from someone who’s researched both sides of the issue and written about it. To that end, I’ve been prepared to be ridiculed and attacked. I’m happy to report that none of this happened - which thrills me, because I consider a number of these docs buds. I've had a number of docs ask intelligent questions. What I never expected (foolish on my part) was to be summarily dismissed by so many.

And this is a huge problem. Dismissal is arrogant. I realize I'm nothing more than an irritant - a bug - and whatever I have to say isn’t important in their esteemed opinion. They’ve already set their bias guns on Stun and decided that a differing opinion is worthy of a shot.

What’s irksome is how docs formulate an opinion based on research that supports their opinions rather than going outside their comfort zone and looking at both sides of the coin. After all, isn't this what good scientists do? Going in with a preconceived notion ignores the data and flaws the hypothesis. In my way of thinking, voicing an opposing voice brings balance to any discussion. As a result, I’m continually asked to defend and justify my opinions (which is only good business), yet when I ask questions of docs, all I hear are crickets.

Not one doc has ever replied to my questions about what patients should do when the medicines they’re taking are just as risky as the affliction themselves, such as hormones for menopausal women create a risk of cancer. What are patients to do when their docs tell them there’s nothing more that can be done for them? I’ve outlined any number of times the hefty helping of skepticism regarding CAM during the research phase of my book, yet I was proven wrong with the betterment of my own health. What of that? Are these not verifiable results? It's achingly easy to chalk something up to the placebo effect rather than consider something non medical can be effective.

I’m pretty sure I’m being dismissed as a whole because I’m not a part of the club. I expected this result, so I’m good with that. But what about the docs who practice integrative medicine, such as the Continuum Center for Health and Healing – the largest alternative care facility in the US and is connected to Beth Israel – or GW Center for Integrative Medicine which is an umbrella of George Washington University Hospital (and where I did my research)? They are part of the medical community. Are their findings summarily dismissed as well because they stand in the face of the medical majority?

As mystified as I am by these omissions of response, I would never declare war on docs or the medical community. It’s ignorant and gets us nowhere. We’re in the fight for health together, and we should be uniting to cure body, mind and spirit. If that makes me a lunatic deserving of disregard, then it saddens me, because I respect the medical community a great deal and feel there needs to an opening of minds and doors.

Some docs claim to be open-minded, and this is lip service at its finest given that they point the finger at CAM practitioners as being the ones refusing to consider any opinions other than their own. I’d like to be shown evidence of proof. I’m not saying it doesn’t exist, but advocates of integrative medicine are continually trying to marry themselves with allopathic medicine in order to create whole body health, so why would they purposefully piss off the very people they’re tying to enlist? On the other hand, I know of oodles of doc’s refuse to listen to these ideas. Until bombs stop being lobbed across the aisle, this will continue to erode all the things that medicine could be while continuing to maintain the current status quo. Complementary Alternative Medicine is one where allopathic and alternatives are complementary to each other – not exclusive, and it makes sense for docs to embrace integrative methods in order to keep a close eye on their use.

Docs want to be shown the science before changing their methods of practice. They want to be proven something doesn’t work before they’ll stop, eg: hormone replacement therapy. I think this article lays out a pretty compelling case. It’s a fact that doctors all over the US are recommending many of their patients discontinue their HRT because it’s been proven women run a higher risk of cancer. I was one of those women, and I suffered horrendous hot flashes. I’ve been under the care of a CAM practitioner for a few years now and am taking natural plant-based substances for my menopause symptoms. Where many of my friends are still suffering, I’m not. Does this have zero validity or interest with my doc friends? Apparently not, because not one of them has ever replied.

Still on the topic of docs wanting to see proof something isn’t working before they discontinue use, how about the new “black box” labels warning diabetics about a high risk of heart failure that Avandia and Actos will soon be sporting? How many warnings on medicines are uttered at light speed on all those nightly commercials? With some, it’s a tossup between which is worse, the affliction or the meds.

This isn’t to say that I’m anti-med or anti-doc. I most certainly am not and would never advocate otherwise. Chemo, for instance, can come within inches of killing the patient, but the benefits outweigh doing nothing. But what about the side effects? Rather than pumping more meds into the patient, why not offer biofeedback, meditation, or Reiki, which have been documented to be very successful in alleviating side effects. So, while I’m by no means anti-med, I am a proponent of seeking the best, most appropriate product or method that offers relief or a cure.

Example: It’s minor in the grand scheme of things, but it does highlight my point. My daughter has warts. Lots of them. On her hands and legs. We’ve spent years having them burned off only to have them grow back or sprout elsewhere. Nothing was a permanent cure in getting rid of them. The cost for the liquid nitro wasn’t insignificant and easily ran into several hundreds. After years of this, Daughter gave up and discontinued the process. An integrative health practitioner offered up a bottle of oregano essential oil. Along with smelling like a pepperoni pizza, within two weeks her warts were gone. All of them. Three years later, they haven’t grown back. This, in my mind, was not only an appropriate alternative, but better than the allopathic choices.

My question is this: are these examples not proof that non-medical means can heal or alleviate suffering? Like everything in life, generalization is a dangerous mistress because of the tendency to throw out the good for the sake of ridding the bad. In most cases this isn’t too big of a problem. But when you’re talking about people’s health and quality of life, is it wise to do this? Would docs rather I stay on my HRTs and risk cancer? Or stay on Avandia and risk heart failure? I’m sorry, but this has the smell of arrogance.

Now, having said this, I do agree that integrative medicine has to be dealt with carefully, and that’s what those $120,000,000 studies by NCCAM are trying to establish. What works and what doesn’t. It’s smart, yet docs lambaste these studies as shoving a bogus idea on to an unaccepting public. It’s not the public that won’t accept the idea of integrative care, but the docs. It’s a damned if you do, damned if you don’t issue. Scientists are chided for “wasting” money on these studies while at the same time, docs scream for scientific proof. You can’t have it both ways. You need to spend money on the studies.

Docs talk about CAM practitioner’s intolerance to criticism, and I have yet to really see this for the simple reason that these people have spent their entire careers justifying, explaining, educating the public and medical society to exactly what it is they do.

Alas, this argument isn’t unlike political opponents who decry anyone with a differing belief as being intolerant. What they really mean is that they, themselves, are intolerant of anyone who believes differently from them. Since the medical community is such a vast lobby, they have the power to keep a differing idea under wraps with claims that integrative care is nothing more than a placebo, it’s pabulum for the idiotic masses, and docs know best.

In my discussion with docs, I’m continually held to a high standard which demands that I have concrete facts at my fingertips at all times and be prepared to sit under a bright light. I agree that this is vital. But it’s irksome that docs aren’t held to those same standards. If someone is going to offer opposition to a practice, it’s only logical to have a balanced and thoroughly researched reason.

After all this venting, I realize that I’m spitting into the wind. Instead, I see comments from those who claim to have an open mind accuse CAM advocates of "doublethink." This dismissive tone is especially depressing because it offers zero chance of there ever being a true sharing of ideas. I could present case after case, and I believe it wouldn’t make a bit of difference. Docs don’t check their beliefs in at the door of their practice, and I can’t help but feel that patients could be the worse for it.

12 comments:

Carver said...

Hi Lynn,

Sorry this is so long but I was biting my tongue so hard on one CAM discussion I thought it might bleed. Feel free to skim or not read. Here's my two cents and all over the place comment.

I am also surprised when I see CAM dismissed. Although I am only seeing "conventional" doctors, thus far, the major research university where I am followed for stage III melanoma has an integrative medicine center as does another university in my area. I don't know if the ongoing clinical trials into herbal supplements (curcumin for melanoma to mention one) are considered alternative but MD Anderson in Houston has had promising results in early trials with curcumin. I haven't followed up on this but I know Sloan Kettering had trials with maitake for breast cancer patients. When I asked my oncologist about maitake since a friend had mentioned it, he kindly had one of the resident doctors bring me a print out. Since there aren't any trials with that supplement for melanoma, I didn't follow up on it.

Duke has been looking at serotonin and the role its levels play in depression and I've heard of trials related to exercise and depression since exercise can boost serotonin.

If you go to clinicaltrials.gov and type in CAM cancer in the search string, 30 recruiting studies come up. If you type in CAM alone, 167 recruiting trials come up.

I had assumed that more doctors were open to CAM based on my experiences. Sloane Kettering and other major cancer centers have information on their websites for patients who are interested in a variety of complementary treatments.

I assumed that the one medblogger I've read who summarily dismissed it was in the minority but I was guessing. Apparently other medbloggers agreed with the CAM dismisser I read but hardly a representative sample so my method of dealing with it was to scratch my head in a bemused manner. I didn't join into the discussion because I'm fairly new to reading med blogs and you seemed to have the dissenting view covered. However, I was surprised that none of the doctors were jumping in to argue some of the points, after such sweeping generalizations were made by those who dismiss CAM.

All the doctors I am followed by are specialists. I wonder if they are more open to CAM. The rheumatologist I see wants me to take two 1000 mg of glucosamine sulfate tabs a day and said he takes that himself. He told me the cheapest place to buy it and told me about the studies they have done in Sweden (I may have the country wrong). He said the clinical trials were with glucosamine sulfate and that I should be sure that's what I take, not the combo which has glucosamine HCL.

Now that I think about it, of the 4 "ologists" in different specialties that I see, all four have been up on various CAM type clinical trials and open to them. Granted this is a non representative sample of 4 but my oncologist, neurologist, dermatologist and rheumatologist have all been open to CAM in discussions I've had.

I doubt they were trying to spread the wealth because I was a high maintenance patient. One commenter on one blog discussed high maintenance patients and how CAM can help with them. However, my doctors see me for standard follow up appointments and I have so many, I will do a lot to avoid extra appointments. Also, none of our discussions about CAM have involved anything that was immediately indicated for me except for the glucosamine sulfate which was something the doctor, not I, brought up. For that matter, most of the CAM discussions I've had with doctors have involved them saying: "they are researching" yadayada with the exception of me asking about maitake.

I think CAM is such a huge field and the lines are so blurred between what's CAM and what's conventional that it's a hard discussion to have without narrowing it down.

Take care, Carver

Voter Mom said...

I like your blog & I agree with your post.
Keep going on going on.

#1 Dinosaur said...

[whimpering with frustration]

Such a long, lovely rant that basically says nothing. I don't see anything in it but anecdotes, generalizations and non-sequiturs.

And I certainly don't mean to be arrogant and dismissive and irksome.

Prove to me that CAM works. That's all I ask. Ever. Hey, I really want it to work. I think it'd be incredibly cool. I love the idea of herbal medicine. I already use ginger for nausea; expand my herbal armamentarium. Please! Far, far from "formulating an opinion based on research that supports my opinion", I WANT to be convinced. Really!!

All I ask is that you "show" me (controlled scientific studies) and not just "tell" me (testimonials and anecdotes.)

If you do, I'll use it. Instantly.

Why is that closed-minded?

But if you study it over and over again (like NCCAM has done) with no positive results, why is it so difficult to admit that it doesn't work? If anything, I find the lack of supportive evidence intensely disappointing personally. That's why I find myself so frustrated here.

I really do understand that lots of folks out there are not well served by their docs, and I think that's more a failure of the docs themselves than of the "conventional" medicine they have to offer. That was the original essence of my first post on the "real" issue about CAM: patients whose needs weren't being met by their docs. I just think trying to twist my mind around how something like homeopathy might work is a poorer use of my time than trying to help that patient.

Lynn Price said...

Hi Carver,
You’re the very patient I normally talk to; the cancer patient. In fact, many cancer patients have bought my novel only because they see docs far more than the average bear and realize there has to be more at the banquet table than the current menu.

Cancer patients are far more likely to investigate integrative medicine because they suffer from so many side effects. Docs can often be heard to say, “sure, CAM? Why not? It gives the patient a sense of having some control.”

This statement always bothers me because it sounds so patronizing. Docs don’t understand that it’s not about having a sense of control – like it’s some sort of platitude that they bequeath to their patients – it’s about empowering patients to take an active, participatory role in their care. I’ve interviewed dozens of cancer patients who had a markedly better experience with chemo and radiation when they supplemented it with Reiki or biofeedback – where my personal knowledge lies.

I assumed that the one medblogger I've read who summarily dismissed it was in the minority but I was guessing.

No, it’s a pretty big number. I remember the same arguments when chiropractors were vying for respectability in the eyes of the medical field. It was very tough going and took a long time. In fact, I know of several docs who generally scorn chiros…but have standing appointments every other week.

At any rate, I really appreciate your feedback. I only wish that docs would come over here and offer a coherent response to their opinions because as disappointed as I am with their stance on CAM, I respect the hell out of their knowledge. Health is an issue that concerns us all, and it only makes sense that we be one the same side.

Lynn Price said...

[whimpering with frustration]

[Lynn hands over a hankie.]

Such a long, lovely rant that basically says nothing. I don't see anything in it but anecdotes, generalizations and non-sequiturs.

Dino, I must have communicated poorly, because my attempt was to present verifiable backup refuting the idea that CAM is restricted to those who wear tie-dye and chant around a banana cream pie during a full moon. If you decide that I have no substance, then there isn’t anything to discuss, which is a shame.

Where we differ is that you insist CAM be able to withstand traditional forms of analysis. If that’s so, then why do cardiologists insist their heart patients relieve the stress in their lives. Given your argument, we can’t stuff stress under a microscope, so where do cardiologists get off telling a patient to reduce my stress levels for the betterment of their hearts? Why have many of them suggested laughter therapy or a reduced work schedule, or even a change of job? That sort of recommendation can’t possibly meet your criteria. What bothers me is your selectivity of what you are and aren’t willing to regard. I submit that patient efficacy trials be given the same respect as a microscope.

On one hand you say that you’re dying to be convinced of CAM’s possibilities, yet you make a snarky reference to doublethink. That’s hardly going in with an open mind. Given this attitude, how is it possible for us to have any sort of meeting of the minds when you dismiss everything I’ve brought up? You state that my testimonials and anecdotes don’t measure up in your eyes. Why? If a patient of yours told you they feel better and no longer have symptoms of menopause, and they’re not on HRTs, are you telling me that you’d tell them, “bullshit, you don’t know what you’re talking about”? How is a patient’s recovery not as valid as a scientific study?

But if you study it over and over again (like NCCAM has done) with no positive results, why is it so difficult to admit that it doesn't work?

Because it’s not true. Again, you’re being selective. Taken from the NCCAM site:
What is integrative medicine?
Integrative medicine combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine.
---------------------------------
Don’t take my word for evidence; I’m nothing more than an author who’s done a great deal of research. Check out ASU’s integrative medicine dept. with Dr. Andrew Weil. Talk to renowned cardiothoracic surgeon, Mehmet Oz. They’ll give you all the information you demand. In short, Dino, the support is there, you’re just not looking.

I just think trying to twist my mind around how something like homeopathy might work is a poorer use of my time than trying to help that patient.

And this says it all. You’ve already made up your mind. You did a cursory review of the studies that support your view and looked no further. I’d never in a million years say that you don’t care for your patients because I know better. But that’s not the issue here; not for me. It’s about enhancing medicine beyond what’s currently available. Docs continually forget that our minds are like hard drives and one infection of a file can affect the operating system.

Okay, that’s probably another anecdote you won’t appreciate, but I find it a nice illustration of how the mind and body work in unison to keep us well…and make us sick.

Carver said...

Hi Lynn,

Thanks for your response to my comment. I agree that the idea of going along with CAM to give a patient a sense of control is very patronizing.

I dug up the MD Anderson news release as an example of a study that has shown promise in the lab setting and I'm pretty sure phase I clinical trials have started:

Potent Spice Works to Block Growth of Melanoma in Lab Test
M. D. Anderson News Release 07/11/05

"Curcumin, the pungent yellow spice found in both turmeric and curry powders, blocks a key biological pathway needed for development of melanoma and other cancers, say researchers from The University of Texas M. D. Anderson Cancer Center.

The study, to be published in the August 15, 2005 issue of the journal Cancer, but available on line at 12:01 a.m. (EDT) on Monday, July 11, demonstrates how curcumin stops laboratory strains of melanoma from proliferating and pushes the cancer cells to commit suicide.

It does this, researchers say, by shutting down nuclear factor-kappa B (NF-kB), a powerful protein known to promote an abnormal inflammatory response that leads to a variety of disorders, including arthritis and cancer.

The study is the latest to suggest that curcumin has potent anticancer powers, say the researchers."

My patient non scientific take on that is that with a cancer like melanoma that's so hard to treat if it's not caught early because it doesn't respond well to conventional chemo or radiation, and with the immunotherapies being so toxic with only benefit for some, there may be more motivation within the scientific community to explore alternatives. Too bad it's like that.

Take care, Carver

Lynn Price said...

Wow, Carver. Very cool study. Thanks so much for sharing.

#1 Dinosaur said...

One more try:

...the idea that CAM is restricted to those who wear tie-dye and chant around a banana cream pie during a full moon.

I never said that. Never thought it. Never implied it.

...then why do cardiologists insist their heart patients relieve the stress in their lives...

Generalization, and false at that. Good ones don't do that nowadays. (Or maybe they still do in California; sorry; still a little hypersnarkemic.) They know that subjective things like "stress" are things that some people thrive on, while others are destroyed by it. But because it's NOT something that can be quantified, I don't feel it's a particularly useful piece of advice. If a cardiologist told a patient of mine "reduce your stress" instead of "these are things that can reduce your blood pressure and cholesterol; we also have meds if they don't work well enough", well, that's the doc whose wardrobe I'd check for tie-dye and whose likely to have a standing monthly order at the bakery for banana cream pie. And besides, what does that have to do with insisting that CAM and traditional analysis?

There are some bad docs out there who aren't very good about evidence-based medicine. It bothers me greatly that their failing -- and their reliance on unproven "conventional" means -- gives CAM adherents grounds to argue that they shouldn't have to prove that their stuff works either.

The problem with NCCAM is that although the link you gave is to the definition of CAM, and although it states that it limits itself to "high quality evidence of safety and effectiveness", none of their research actually meets this criteria. How do I know? First of all, I've read it. Eagerly, yet I've always been disappointed. Besides, don't you think any real, verifiable, positive results would make front page headlines in the regular media? Damn straight. Has it? Nope, and I for one am bummed big time.

Regarding my view of testimonials, you are putting words in my mouth big time, and it's totally unfair.

I have patients who have responded fantastically to "CAM": one lady with a history of multiple infections -- and not vague stuff like chronic lyme but recurrent pneumonia needing hospitalization and cervical dysplasias from HPV -- told me she started taking Juice Plus, and all her infections stopped. Although there is absolutely no acceptable scientific evidence that the ingredients in Juice Plus should do something like that, I told her, "Whatever you do, don't stop taking it."

I rejoice when patients get relief, however they get it. But it would be pretty irresponsible of me to start advising everyone with an abnormal pap to start taking Juice Plus (when condom use and smoking cessation have better quality evidence for enhancing HPV clearance.)

One man with diabetes claimed that a tablespoon of cinnamon every day helped lower his blood sugars. Cool. For him. Do I start prescribing it for everyone? (Actually, that one's innocuous enough that I have suggested it to some other people.)

I'm thrilled for you that Reiki cured your hot flashes. But what if someone had branded you with a hot iron, and that's when your hot flashes stopped? Should we then condone branding as CAM? Testimonials are fine for individuals, but are you suggesting that I should change the way I practice based on anything that's ever worked for any given patient? That's what I'm not willing to do.

Homeopathy is water with memory. How on earth do molecules of water "remember" what other molecules they've been in contact with? Or, technically, with molecules that other nearby molecules may or may not have been in contact with? If I were to try and explain that to any patient of mine with better than a fourth grade education, they'd look at me like *I* was wearing tie-dye and offering them banana cream pie.

I did NOT just do a "cursory view of the studies that support [my] view and looked no further". I went in looking for confirmation that these nifty CAM things worked. But I read multiple studies; multiple reviews of multiple studies; meta-analyses of multiple studies (ok, that's redundant) and was sorely disappointed to find that none of them (even my favorite, acupuncture; hell, I took my dog for a whole year of it and she got better) stood up to well designed studies. That's why it really stings to be told I'm not finding it because I'm not looking for it.

#1 Dinosaur said...

As for the snark, it's a hazard of the blog persona.

Lynn Price said...

This answer pertains my statement that discussed cardiologists who recommend patients consider their stress levels:

Good ones don't do that nowadays. If a cardiologist told a patient of mine "reduce your stress" instead of "these are things that can reduce your blood pressure and cholesterol; we also have meds if they don't work well enough"
Yes they do. Mehmet Oz is a leading cardiothoracic surgeon, and he discusses the importance of reducing a patient’s stress levels all the time. My neighbor’s doc told him flat out to reduce his stress or he could be facing a major blow out next time around. This warning was given along with a long list of meds. Yes, I’m reciting anecdotes again, but I see the validity in these stories, because they set a pattern of treatment that transcends conventional medicine. Remember, I would never suggest any doc forgo clinical treatment, but I am suggesting that docs offer complementary choices that can enhance healing or relieve symptoms.

Regarding my view of testimonials, you are putting words in my mouth big time, and it's totally unfair.
Dino, it’s not my intent to put words in your mouth and no insult has ever been intended. Like you, I call them as I see them. All I have is what you write, and if I’ve misinterpreted you in any way, I apologize. I respect you a great deal; you know that.

I have patients…recurrent pneumonia needing hospitalization and cervical dysplasias from HPV -- told me she started taking Juice Plus, and all her infections stopped. Although there is absolutely no acceptable scientific evidence that the ingredients in Juice Plus should do something like that, I told her, "Whatever you do, don't stop taking it."
Bravo for you! Honestly, this is great. Your reaction is far from the norm.

it would be pretty irresponsible of me to start advising everyone with an abnormal pap to start taking Juice Plus (when condom use and smoking cessation have better quality evidence for enhancing HPV clearance.)

One man with diabetes claimed that a tablespoon of cinnamon every day helped lower his blood sugars. Cool. For him. Do I start prescribing it for everyone? (Actually, that one's innocuous enough that I have suggested it to some other people.)
Why is cinnamon okay to suggest but Juice Plus isn’t? Aren’t both innocuous? What I see in this scenario is a pick and choose attitude. Cinnamon hasn’t been subjected to clinical trials, and there isn’t scientific evidence of its efficacy, yet you suggest it. You do this and in the same breath, claim that individual testimonials aren’t valid.

If one uses innocuity as a primer, then what’s wrong with complementary medicine? Who’s getting hurt by these modalities (I’m pulling the modalities used from Continuum Center for Health and Healing) ? We’re talking about benign treatments that are used alongside allopathic medicine. At the very least, you have a relaxed patient, and I think we can all agree on those health benefits. My question to docs is why is this such a frightening idea? Anyway, as you mentioned before, we have to agree to disagree, and I can’t tell you how much I appreciate your stepping up and opening a dialog. From this, we can appreciate the vast divide that encompasses the medical community, and, ultimately, that’s why I wrote my book in the first place. And believe it or not, my book is neither pro or con regarding CAM.

Bongi said...

beetroot and garlic have less side effects than antiretrovirals, but i'd venture to say are less effective too.

maybe i'm not the one to comment here. sorry.

mark a said...

I realize that I am a late arrival on this one but had to post a comment none-the-less. The problem as I see it are probably too numerous too mention in a comment section. Certainly there are allopathic physicians that shouldn't be practicing, just as there are CAM practitioners who are in it for the money.

Many valid points are made here. -Any medication has risks associated with and it is up to both the patient (primarily) and the physician to decide if the risk benefit ratio favors use or discontinuation. Some woman choose to stay on HRT because their hot flashes were so severe. The risk of cancer while real is relatively small. Ofcourse that depends on how you work the numbers.

* Among 1,000 postmenopausal women who don't use HRT, there will be about 32 cases of breast cancer between the ages of 50 and 65. (3.2%)
* For every 1,000 postmenopausal women who take oestrogen-only HRT for 10 years, there will be 5 extra cases of breast cancer. (an additional 0.5%)

-Many of the drugs used, including chemotherapeutic agents, estrogens, antibiotics are "ALL NATURAL" in that many drugs are derived from things found in nature. One of the points that many people fail to understand is that 'all natural' does not mean 'without side effects'. Drug companies screen hundreds of thousands of natural plants etc in an attempt to find new therapeutics.

Theoretically the 'natural' plant estrogens beings used for the treatment of hot flashes can have the same risk of cancer as the traditional allopathic HRT. The problem is no large study on these drugs, such as the ones done with synthetic estrogens, has ever been done.

Yes, ignorance is bliss, but while there certainly are problems with the drug industry and allopathic medicine at least the effort is there to actually provide the patient with the best possible information regarding side effects and risk. Can that really be said of some CAM therapies? (note I said some, not all CAM therapies).

Finally, and I am not saying all CAM fall into this category BUT, the placebo effect is still very much alive and well in all aspects of medicine and our own idea of what should happen plays a role in many disease states. The problem is that allopathic physicians don't have the luxury of prescribing a placebo as SOME CAM practitioners can.

Aspirin is all natural, derived from the bark of the willow tree yet people die from asprin. Digitalis form the fox glove plant. Antibiotics from various fungi and molds. Cyanide is all natural but I'd rather not take it.

My own institution has a CAM program and I eagerly await the time when I can prescribe or tell my patients about a CAM therapy that will help and what the risks are and what the side effects might be. The best way to do that is not to rely on a placebo effect but to actually do the study.

Yes, much longer than I intended. My apologies.