Quite to my surprise, apparently I’ve become fairly well known as a critic of so-called “integrative medicine,” that which used to be called “complementary and alternative medicine” (CAM) but whose name was changed because its practitioners didn’t want to be “complementary” to anything. Rather they wanted their woo to be co-equal with science-based medicine (SBM). Before that, what is now “integrative medicine” after having been CAM was known as “alternative medicine.” (The wag in me can’t resist further pointing out that before that it was mostly known as quackery.) As I like to say, the only thing “integrative” medicine adds to SBM is pseudoscience. I do my several blog posts per week, most here, at least one a week at my not-so-super-secret other blog, and people actually read the brain droppings I want to throw out into the ether. After over a decade, I still have to pinch myself, but even with my tendency towards extreme (for the Internet) logorrhea, I still have a readership.
One of the questions that keeps recurring over the years is: Why? Why are patients drawn to unscientific medicine. Make no mistake, the whole point of “integrative medicine” is to integrate medicine that has not yet been validated by science (or has even been disproven by science) with real, science-based medicine, although advocates of “integrative medicine” are very good at convincing themselves that they are just as science-based in their practice as any of us. Not surprisingly, they become very unhappy with me when I argue otherwise.
A couple of weeks ago, Scott Gavura mentioned how quackademic medicine has ppretty much completely overrun his alma mater, the University of Toronto. He was not alone. Joe “Dr. Joe” Schwarcz, a professor of chemistry at McGill University and director of McGill’s Office for Science & Society, which is dedicated to demystifying science for the public, was also harshly critical of the dean of the Leslie Dan Faculty of Pharmacy at the University of Toronto for running a clinical trial of homeopathy for attention deficit hyperactivity disorder (ADHD), criticism that led to Heather Boon, the dean and PI of the study, to fire back. I don’t want to discuss exactly what happened here, given that Dr. Joe’s article, a post by Dr. Gavura, and another post by a certain “friend” of the blog all discuss those issues in detail.
Rather, I want to use a post by Dr. Mario Elia as a jumping off point. The post, entitled The lure of “integrative medicine”, begins thusly:
It has been fascinatingly frustrating over the past couple of weeks to see faculty and students at the University of Toronto defending “alternative” and “integrative” and “holistic” medicine with all of their might. They are portraying this entire issue as an “us vs. them” debate, as if anyone opposed to the idea of integrative medicine is also blind to new ideas, opposed to non-prescription treatments, and has no interest in patient satisfaction. Nope, we actually care about all of those things. And we care about the patient’s pocketbook and about the scientific method.
This is another example of the false dichotomy of CAM (or integrative medicine, or whatever you want to call it) that I’ve lamented so often, albeit in different terms. Usually, I point out that being a “holistic” physician does not require the embrace of pseudoscience. After all, that is a key implication often made by proponents of integrative medicine, namely that you have to embrace pseudoscience like acupuncture, homeopathy, naturopathy, and the like in order to be a truly “holistic” physician and take care of the “whole” patient. Obviously, they don’t put it in those terms, but that’s the bottom line in many of their contentions about the usefulness of integrative medicine. Opponents of integrative medicine are often painted as believing in “scientism,” of not caring about the whole patient, and the like. As Dr. Elia points out, we’re also frequently painted, either by implication or by assertion, as not caring about non-pharmacological treatments of various conditions and of not caring about anything that science doesn’t understand very well.
Now here’s where Dr. Elia nails it. He describes a patient encounter with one of his patients who has hypothyroidism. This patient also regularly saw a naturopath, who offered her a boatload of the usual things that naturopaths offer, such as supplements and herbal medicines. (As an aside, I’d like to mention here how I frequently laugh at how practitioners of SBM are accused of “pill pushing” and of only wanting to give patients a prescription for a medication that will help them when so often naturopaths and other alternative practitioners want to push supplements and herbs as the cure for what ails their patients. The difference, of course, is that as a physician I can’t sell the pharmaceutical drugs that I presribe to my patients. Naturopaths and alternative practitioners can sell their patients the very supplements that they prescribe. But I digress.) In any case, after Dr. Elia found out what supplements his patient was on and trying to explain to her as gently as he could that there was no evidence that any of these supplements did anything for her hypothyroidism, this is what happened next:
I paused and asked her “What exactly about how you feel do you wish were different?”. She said she wanted to have more energy and be less stressed and angry. I asked how she feels when she leaves the naturopath. Fantastic, she said. After a fascinating discussion with her and her husband, I learned that my patient is quite religious, and has been frustrated for the past decade that she hasn’t found anyone locally who shares her sense of spirituality. Until she met this naturopath, as they have very in-depth discussions about her faith. I explained to her that the benefit she is seeing from the naturopath is from a sense of camaraderie, and not any diets or supplements or treatments she is offering. I told her that she can feel free to continue seeing the naturopath, as long as she realizes she is essentially paying for companionship. The pricey supplements and herbs are just along for the ride, and are unproven in terms of safety and efficacy. An expensive placebo while the companionship provides all of the benefit.
As I said, I think Dr. Elia nailed it here. Remember all those studies over the years that I’ve discussed about, for instance, acupuncture, in which the provider-patient interaction was as important—or more so—than any nonspecific effects of the acupuncture (e.g., this one)? This is the distillation of what “integrative medicine” really is, for the most part.
But what’s in it for the integrative practitioner? I suspect it’s reclaiming something that has been lost over the last couple of decades, the physician-patient interaction. As the financial pressures of practicing medicine have grown and patient face time has declined, it’s understandable that some physicians would like to reclaim “the way it was,” whether it ever really was that way or not. There exists in the collective consciousness a concept of the physician along the lines of Dr. Marcus Welby and Dr. James Kildare, kindly, benign figures whose influence and good intent were unquestioned by patients. Doctors also long for a perceived time when the will of the physician was generally unquestioned, and patients did what they were told.
I’ve frequently referred to this apparent view of the role of the physician in the physician-patient interaction by proponents of “integrative medicine” as that of the shaman. Indeed, no authority less than “America’s doctor” himself (or, as I like to call him, “America’s quack”), Dr. Mehmet Oz, has said just this, as I pointed out two years ago, citing an article about him by Michael Specter:
“I would take us all back a thousand years, when our ancestors lived in small villages and there was always a healer in that village—and his job wasn’t to give you heart surgery or medication but to help find a safe place for conversation.”
Oz went on, “Western medicine has a firm belief that studying human beings is like studying bacteria in petri dishes. Doctors do not want questions from their patients; it’s easier to tell them what to do than to listen to what they say. But people are on a serpentine path through life, and that is the way it is supposed to be. All I am trying to do is put a couple of road signs out there. I sit on that set every day, and that is what I am focussing on. The road signs.”
It’s that role, that some doctors crave (and understandably so), that of the healer. Unfortunately, to attain such a role, all too many of them have embraced pseudoscience to the point of advocating “integrating” it into medicine. As I’ve pointed out before, throughout most of human history, that was the role of the physician/healer. It took many hundreds of years, which stretched into thousands of years, before it was fully accepted that medicine should be based on science. Arguably, it wasn’t until just over a century ago, with the advent of the Flexner Report, that medicine, in the U.S. at least, was placed on a firmly scientific basis. Indeed, what we now know as randomized controlled clinical trials did not see their debut, much less become the basis of determining which treatments worked and which did not, until the 1940s. Although physicians have been trying to base their craft on science for hundreds of years, it’s really only been in the last century or so that they’ve succeeded.
Yet still some would like to go back to the way it was. They yearn for the days when doctors were “healers” and shamans, the way medicine was for hundreds and hundreds of years before science intruded. Indeed, I’ve lost track of how many times I’ve taken notice of rhetoric from practitioners of “integrative” medicine that basically says just this, usually with the implication that to attain that hallowed role of healer requires the embrace of various pseudoscientific—or perhaps I should say prescientific—treatments. And it works, too! Dr. Elia illustrates this with a question:
Can you imagine if physicians used the same predatory techniques that these alternative practitioners do? A patient comes in with viral pharyngitis, and I tell them it will resolve on its own, not to worry. It resolves on its own within 48 hours. Or….I could offer them some special herbal concoction, and voila! The herbs cured the sore throat in just 48 hours! Amazing! Dr. Elia is the hero! Patients need to realize the humility that physicians show in allowing the concept of tincture of time to run its course without creating a false sense of a cure through bogus practices. I am bound by evidence and science, not by pricey cures and by the ego-boosting of “curing” illnesses. The public would truly be amazed at the proportion of my day spent simply ruling out serious disease and providing reassurance, allowing time to take its course. Not as sexy as being a hero, but it’s the only ethical way to practice.
Indeed.
Of course, that’s the problem with “integrative” medicine. Basically, it is based on using interventions that either haven’t been shown to work or have been shown not to work and then taking credit for what would happen anyway even if the practitioner did nothing. Now, don’t get me wrong. Practitioners of SBM are sometimes guilty of this as well, but SBM isn’t built on the very model of placebo effects and regression to the mean. Integrative medicine is. SBM is all about producing real therapeutic effects. Integrative medicine doesn’t much care if there’s a specific effect. After all, any specialty that embraces naturopathy, traditional Chinese medicine, homeopathy, and even “energy healing” can’t be too concerned with verifiable science, its protestations otherwise notwithstanding. As I’ve said before many times, the “central dogma” of alternative medicine/CAM/integrative medicine is that wishing makes it so.
It’s not for nothing that I (as well as Kimball Atwood) have referred to CAM as the “new paternalism.” It’s not SBM that’s paternalistic.
“Integrative health practitioners” often point to patient satisfaction as a rationale for their existence and for funding, which is completely insufficient as a measuring stick for appropriateness in health care. We know that simply having an individual listen to your concerns and show empathy will improve outcomes, regardless of the form it takes. So take Reiki, and craniosacral, and therapeutic touch, and any mind-body energy life-force practices, and call them what they truly are. Relaxing companionship. Then let’s have a discussion about whether public funds should be directed towards that end. And let’s tell private-paying patients that they are paying for companionship and relaxation. But don’t try and explain these techniques via unproven scientific principles as a means to give them legitimacy. Perhaps many of these practitioners can work to develop self-directed education programs for patients to help those improve their own stress. Less lucrative, but far more patient-centred.
I’m not going to hold my breath waiting for this to happen.
51 replies on ““Integrative medicine”: The lure of the shaman healer”
“I would like to take us all back a thousand years…”
—- Dr. Mehmet Oz
Indeed.
One might think that selling supplements and hand holding are somewhat easier paths of study and income generation than, you know, science.
In my younger days, physicians were expected to have a good “bedside manner”, or so the talk went. They were at most half joking. But financial pressures have pushed physicians away from that model, and I think you and Dr. Elia are correct to see that “integrative” practitioners are trying to exploit this gap. People often want a sympathetic ear, and sometimes they will pay good money for it (ISTM that many therapists work on this business model). But that leaves them vulnerable to charlatans. It’s a variation on “The Emperor’s New Clothes”.
I don’t want to be taken back a thousand years and I doubt anyone would really want that. At least if they realised what living a thousand years ago really ment.
it’s a vicious cycle which seems to “work” for both parties.
The patient gets the sense that someone is listening to them and allowing them to “control” their health and heal themselves by paying for supplements, meditating or whatever.
The CAM practitioner gets paid for essentially nodding reassuringly and selling them useless stuff.
Unfortunately they create an echo chamber around themselves via friends and social media which validates all of this and drowns out anything they don’t want to hear.
Many SBMs would agree that a good bedside manner, companionship etc. are all potentially important to a patient’s (primarily mental?) wellbeing but given the economic pressure they are under if something has to give then this is the first casualty.
“Doctors do not want questions from their patients…”
Bull f#cking sh!t Mehmet you arrogant twit. In my experience you can have a good partner in health if you approach a physician with an inquisitive humility, the very opposite attitude of what CAM tries to instill in their clients: every alternative practitioner I saw pissed away privately on idea that doctors don’t know very much, that they are mostly incompetent boobs except in the ER. The distrusting insistent ignoramus-savant CAM would have you become would try even Marcus Welby’s patience.
The CAM-patient relationship is about a secret knowledge shared with you because you are so special to have come to CAM. Saccharine lather applied to egg you on and keep you coming back for more. Doctor Oz soils himself on national television and you smile knowing you are lucky to be a part of this.
Indeed. The way many alt-medics and friends talk, I often wonder: Have you been to a doctor lately? They don’t always have the time we’d like but nor are they trying to sign you up for weekly crystal hugging sessions either. Generally, I find that they try to address the problem as quickly as possible, via the least onerous means whilst accounting for patient needs and preferences. In an ideal world, they’d have nice rooms and herbal tea and decent food in hospitals which would achieve most of the ‘benefits’ of CAM without the fairytales plus bonus science. Now that’s real ‘integrative’ medicine.
Another aspect to CAM therapies I’ve noticed could be termed: things that do work but are not particularly exciting or able to be trademarked without accessories or a hefty dose of pointless ritual. E.g. eating vegetables, regular exercise.
Excuse me now while I take my ancient African seed-based tonic to stimulate mental clarity and increase energy.
@DevoutCatalyst.
OK I feel like I need to find out where Dr. Oz did his residency and avoid anyone from that program if they were trained to never listen to patients, ever. YIKES!
The only questions from patients that I’ve heard docs don’t like is the so-called door knob questions. You’ve gone over everything, did the tests, did any teach-back needed (where the patient tells you in their own words what the problem or treatment is) wrote the prescriptions, made the referrals and you put you hand on the door knob and the patient says something like oh doc, just one more thing…and it usually is some kind of alarming symptom that would have changed everything in the above list had you only known about this at the beginning of the appointment.
It is one of those human quirks where if we are really scared about something, or embarrassed we tend to put off bringing it up and then all of a sudden the appointment is over, especially if you’ve been fretting about it and wondering how to bring it up and may not even have really heard the important info about the other thing.
I just noticed, that we don’t see much striving for integration in other branches of science.
I’d love to have resources required to invite the most vocal integrative medicine to a flight in plane organized in the spirit of integrative aeronautics.
In the middle of the flight the pilot would be replaced with shaman in trance connection to the Great Condor who’d steer them to safety through his holistic and natural understanding of how birds fly. And tank would only be filled to half capacity, since after the initial part of journey incense and focused will of passengers will suffice to take control of the journey, to creathe their path to flight. Well that and maybe some coffee enemas.
The news reports today that Cassandra C.’s cancer is in remission. http://tinyurl.com/nn7gyjt
There’s no word from Cassandra herself, so mom Jackie Fortin is still running the show, and lawyers are apparently still trying to fight the State mandate. But Cassandra’s doing the treatments, and the docs are reporting progress. Perhaps she’ll be clear by the time she turns 18, should she decide to forgo further treatment at that time?
Agreed. Although this is probably alt-med spin on what I imagine doctors were actually told, which is something more like “Never put patient comfort above patient health, should the two ever be at odds.” Which, in an ideal world, they would never be. But patients are notorious for wanting to do what feels good, rather than what is good for their health. It is the job of the doctor to persuade/teach them otherwise.
@ The Smith of Lie:
I should ask my cousin, an architect, if there are any recent innovations in complementary or integrative architecture.
I can imagine that outdated concepts like the arch and cantilever might be replaced with more spiritually relevant formulae like praying that that wall will hold or wishing for a sufficiently strong foundation.
@Orac
It’s actually a very good point worth repeating, because it’s a prime example of the cognitive dissonance – or should I say, hypocrisy – of the alt-med practitioners.
Homeopathy is all about pill pushing, chiropracty is all about visiting every other week if not more often…
Not to mention the detox crowd which is all about cleansing oneself by pushing chemical stuff one way or another into one’s body.
MNA: In an ideal world, they’d have nice rooms and herbal tea and decent food in hospitals which would achieve most of the ‘benefits’ of CAM without the fairytales plus bonus science. Now that’s real ‘integrative’ medicine.
Oddly, I’ve had an idea very much like it, but it’s more to encourage vaccination. Parents who vaccinate, regardless of income level, get tea, snacks, toys for the kids and reading material that was published within the last year. Parents who don’t get the room with one flickering lightbulb, no tea or toys and reading material that’s older than their kids.
I am very lucky. My family doctor makes his patients feel very comfortable. From the moment he comes to the waiting room to greet me, shakes my hand and walks me back to his office I start to feel better. Oh, and when warranted he prescribes real medicine or finds a specialist for me.
In my experience the specialists are more likely to see me as an inconvenient vessel for a particular problem.
Smith @9: I take it you don’t live in the US, because we have plenty of that happening here. Consider how difficult it is in the US to get high school biology classes to mention evolution. Or more recently, witness the Department of Environmental Protection in a US state that is particularly susceptible to seal level rise (because in many areas of the state, 5 m elevation is high ground, relatively speaking), being banned from using the terms “climate change” or “global warming”. We have now had 360 consecutive months (30 years) of global average temperatures above the 20th century average–that’s significant because 30 years is the standard minimum baseline for determining what climate is.
Denice mentioned architecture. There is something called “feng shui”, alleged to be of Chinese origin (as you might guess from the name), which has significant effects there. But at least feng shui practitioners don’t doubt the calculations of structural engineers regarding what is needed to ensure the building remains standing; they are more concerned with placement and aesthetics.
#12: Monty Python has something on belief-based architecture:
http://www.montypython.net/scripts/mystico.php
The skit itself is on YouTube, somewhere.
Um, I can’t point and laugh at Florida as my state legislated the rate at which the sea may be allowed to rise.
Denice, we must of course remember the amazing Mystico and his assitant Janet, who put up blocks of flats by hypnosis. They work great as long as people believe in them. 😉
Mr Verybigliar: Well there is a considerable financial advantage in using the services of El Mystico. A block, like Mystico Point here, would normally cost in the region of one-and-a-half million pounds. This was put up for five pounds and thirty bob for Janet.
We have the relaxing companionship here in PDX:
Cuddling professional Samantha Hess of SE Portland fills the need for love — nonsexually
http://www.oregonlive.com/portland/index.ssf/2013/11/professional_cuddler_samantha.html
*bril*
Love this blog . . . thank you all for expressing so clearly and completely what I can not. I’ve tried to explain to friends and acquaintances that MMS won’t cure cancer, that there isn’t a secret cure for HIV infection, that a “colon cleanse” is really just sh**ting and apple cider vinegar can’t perform miracles, etc. I’m usually accused of contempt prior to investigation, which is true, but is it just lazy to not “see for yourself” the benefits of a hydrogen peroxide enema? It totally amps up my PVCs to engage with these people, so I don’t. Oh, did you know that beet juice will help cardiac dysrhythmia?
My light bulb went on in 1995 while was speaking on a panel that included Christine Maggiore. I had no idea who she was (I don’t think she was yet the “somebody” she became). It turned out we’d had the same M.D. at some time — my experience with him made me much more interested in SBM. Christine, obviously, not so much. At the time, I just thought she was making some unwise choices concerning her healthcare.
The healer/companion characterization hits it on the head. In addition to taking a lot of prescribed medication and participating in many clinical trials, I played with CAM because ***I liked the attention***. It always felt like the benefit, to me, was the feeling of being ministered to. I never had any belief in the CAM, itself. The needles, the stinky herbs and the annoying new age muzak were all just things to be endured while a kindly person made nice on me. Although I felt the treatments were bogus as f***, it was for the most part, sweet to be treated sweetly —> and it was FREE. There really was that time for us (HIV infected) in the 80s to mid-90s when it felt there relatively little else to do. If nothing else, it was a diversion. It’s gruesome that some were sucked over the event horizon, into total delusion.
Things have changed and CAMmers seem much more aggressive now. There’s a pervasive “ortho” vibe EVERYWHERE that’s like a magic carpet for this stuff to travel on. They are a pain in my ass, even though I really have nothing to do with them.
I’m very grateful to all of you who are able articulate (and back up) this stuff so well . And to the woophiliacs who frequently comment: please continue to toss those logs on the fire. It helps to keep the fire of reason burning bright.
Take us back just a few hundred years to get the cartoon on my fridge: “Yes, it’s a golden age, or could have been, were not everyone swarming with lice.” (add your own infectious disease.)
2nd thought: The idea that maybe we just need more therapist types might be worth investigating. Insurance pays for lots of that. It might be admitting you have a different problem than you wanted to have though.
Yeah, there are snuggling services popping up all over the place. I find the idea a bit weird myself, because
1. I’m definitely not comfortable inviting a stranger over to my apartment to cuddle with me, and
2. what’s the other option, cuddle with a stranger in public?
Plus I have a gay faux boyfriend I can snuggle with.
Yeah. I have some friends back in PDX who see SCAM artists for various chronic ailments. I have a feeling that the ailments have one name and that name is depression, but somehow saying that would come off as an insult.
I mean, I can sort of see why people want to have a physical illness instead of a mental illness – physical illnesses tend to garner a lot more sympathy and understanding. Nobody expects you to “snap out of” lupus.
I see from the link she charges $60/hour. She must be really good at hugging. I’ve worked a helluva lot harder for a helluva lot less.
Yes, the patient was clearly interested in the camaraderie but I think there’s more than an expressed desire for companionship in this confession. What about religion? The patient was having her spiritual views reinforced. She was essentially going to a religious leader who also provides evidence for ‘miracles.’
My pro-alt med friends are very clear indeed that CAM is a matter of faith. It involves spiritual forces or metaphysics directly linked to Mind over Matter (ie wishful thinking in full blown New Thought armor.) All of their defenses — and those of other proponents — smack of the very same apologetic approaches and arguments atheists get from people who believe in God. And the very same indignant outrage over insensitivity and incivility. It’s a choice which should never be “attacked.”
A lot of people probably do like the friendly attention. But when health is specifically extended into mind, body, and soul, it looks to me like that the last one is what is uniquely being integrated into “integrative” medicine.
Q: What’s the distinction between logorrhea and being satisfyingly thorough?
A: A satisfied readership.
Denice, does feng shui qualify as complementary architecture?
For sixty bucks a whack I’d expect a lot more than a cuddle.
Speaking as someone with a thyroid problem and who takes synthetic thyroid hormone –
Taking supplements recommended by the naturopath could well be interfering with the thyroid medication that this patient is taking. Dr. Elio doesn’t say whether he explored this with the patient. It is known that calcium, magnesium, zinc, aluminum and iron supplements interfere with thyroid hormone absorption. I bet anything that the naturopath is recommending mineral supplements.
It sounds like the patient had some inkling that the supplements might be causing an issue, which was probably why she wanted the doctor’s opinion of them, and also why she continued to feel unwell. Instead of discussing these issues, however, she got a talk about companionship and placebos.
I’m not certain what the situation is like in Ontario where Dr. Elio practices, but if it’s like the US, he probably doesn’t have the time to sit down with a patient such as this and go over the details of what they are taking and how they need to manage her condition. Which just pushes this type of patient back into the arms of the naturopath, where her medicals needs are not being met, on top of wasting money.
Rork: “The idea that maybe we just need more therapist types might be worth investigating. Insurance pays for lots of that. It might be admitting you have a different problem than you wanted to have though.”
Rork, I’m guessing you live somewhere other than the U.S. As far as I know, insurance in the US doesn’t pay for therapy, and if it does, it’s only for three months or so. And that’s assuming the insurance company doesn’t dump the person for having depression or some other thing.
No longer a thing (pre-existing conditions, that is) since the ACA took effect. Yay.
But yeah, mental health coverage is woefully inadequate on many plans. Mine has shockingly good mental health coverage, all things considered; I guess the university has some interest in not having grad students jumping out of windows or something. Although having windows that don’t open, at least in my building, would seem to put the kaibosh on that anyway.
Well I guess we can add this to the ever-growing-list of things you don’t know but try to speak authoritatively about.
@Renee #28, my doctor’s office asks about all the medications I take, and make it very clear that they mean all of: things someone has prescribed, any OTC medications, any vitamins, and supplements. And every visit they give you a copy of the whole list for you to mark any changes on, it’s all in their computer system and absolutely everything is cross-checked for interactions. One of the pluses of being in a medical group affiliated with a university in a tech-happy area, I guess?
O/T, but in case our esteemed host is looking for blogfodder, the Encyclopedia of American Loons had an interesting piece on Daniel Amen.
The Encyclopedia appears to be on its third pass through the alphabed — there are always more where those came frome.
Eric Lund # 16
Well yes, I live quite far from States. Far enough that we only just started picking up on the trend to believe that vaccines cause autism about year or two ago and it still is relatively minor thing.
I admit I did not account for things like creationism or global warming manufacturoversies in my previous post. Still I stand by my point that one does not see the same push in areas where hard and fast science happens with binary outcomes. I doubt even the biggest enthusiast of feng shui would want his home blueprints to be created by a guy who has no formal knowledge of architecture.
I think it would just satisfy my vindicative streak if I could watch all the woo meisters forced to choose between their woo and science based solutions in a very quick and binary life or death situation.
@#28 Renee
My clinic here in the Midwest (hardly a hotbed of hi-tech) is the same as Emma describes. It was the same when I lived elsewhere (three other states). Every doc I’ve been to in the last 15 years (I move a lot) ask about all medications and specifically asks that you include any supplements or herbal stuff. This sheet is in your file (or on the computer these days). I also think that Dr. E from Ontario would have considered this aspect even if he didn’t specifically mention it.
JP: Although having windows that don’t open, at least in my building, would seem to put the kaibosh on that anyway.
Gotta love those 19th century buildings. I lived in a dorm like that one summer- I could probably have baked bread on my desk.
Science Mom: I have insurance, I just have never bothered to use it to attempt to get therapy or even medication(in fact, I haven’t used it at all in a couple of years.) The insurance companies can and do rewrite the coverage constantly. And if anyone actually believes that the ACA will still be around in 2016- well, I have landmarks that are on sale.
Eric Lund @#3
Perhaps one way to think about CAM is that “bedside manner” has become a sub-specialty.
It’s actually 20th century – a truly hideous artifact of red-brick brutalism. The local myth about the non-opening windows is that, since the building was built in 1970 or thereabouts, it was made to be riot-proof and bullet-proof. (The campus was considerably more radical once upon a time.) I think a more likely explanation has something to do with heating, cooling, circulated air, etc.
The windows in my apartment building do open, but I am only on the second floor. Alas.
I have insurance, I just have never bothered to use it to attempt to get therapy or even medication(in fact, I haven’t used it at all in a couple of years.)
Hmm. I think I remember, a few months back, you mentioning going off an SSRI, although I may have you confused with somebody else. Was it unhelpful? Were you seeing a therapist at the time? The places I’ve gone to, you had to be seeing a therapist in order to see a psychiatrist. I did find that therapy had some value in helping to keep my head together, although I got pretty discouraged with it ultimately due to a failure to find a therapist I could “click” with in any significant way. I suspect this may be due to being too smart for my own good.
^ The “I have insurance” bit was supposed to be in a blockquote.
What is the number one used form of medicine on the planet?
JP: The SSRI was either in college or high school, back when I could be sure of coverage. I’ve been on two different ones, and found them both equally unhelpful. I wasn’t seeing a therapist when I was on either. I think either my pediatrician or my other doctor (probably the other doc) prescribed them for me. Therapy never came up.
Don’t shift the goalposts and try to obfuscate because you are called out for talking through your arse again. Take this advice or not but just stop making ignorant blanket statements based upon your own narrow worldview and scant life experience. You’re really just embarrassing yourself.
@PGP:
Huh. Yeah, the whole phenomenon of GPs prescribing antidepressants is a little weird to me, and it seems extremely common.
Given that you do have insurance, if you think it might be helpful, you might look into seeing if they do offer coverage for therapy. A lot of plans do only offer a certain number of weeks, or only CBT, say. It can be helpful in general to have somebody to bounce one’s cognitions and assumptions off of.
Of course, a good friend can be helpful in that regard, too.
Where I’m from, the standard procedure seems to be that they prescribe antidepressants, and if that doesn’t work then they send you to a therapist. Given that pills are cheap and therapists are not, that may be a sensible way to spend healthcare funds efficiently.
Myself, I was on SSRIs for a few years; they weren’t unhelpful – I wouldn’t be sure I’d be around here to type without them – but neither did they bring me back to normal. The first therapist I got sent to didn’t seem to make a difference, but when I got a new one things “clicked” and I improved fairly rapidly.
We’ve been through this. There are different excuses, such as losing the insurance and vague surveillance concerns.
Sciencemom: Like anyone even understands health insurance.Can you tell me what your insurance coverage covers and what it does not, this year? How about next year?
JP: I think that’s always been the case, at least in the US. Therapy might be helpful, but it can wait, until I have some gold-plated insurance plan. I can always talk to the cats and dogs I look after. Friends would be nice, but the one I could trust moved away.
I got a booklet not long ago with complete details on what my insurance does and does not cover, along with a notice that my copay had gone up again, to $25, which is still not bad. I’m guessing this is pretty typical, though if you don’t have a current booklet, such information can be found online.
Can you check what your non-gold-plated insurance plan covers? It might be more than you think. And I wouldn’t be too worried about losing coverage for using it. GradCare is admittedly pretty good insurance, but I’ve used it quite a bit, and so far, so good.
Dogs and cats are great, but they don’t talk back, to my knowledge.
Do you have a phone? Or an email account?
Speak for yourself. And speaking of which, if you don’t understand the topic, then why are you making such blanket statements about it? Again I assure you that your myopic experiences do not even begin to scratch the surface of our complex world.
I have exceptionally good insurance coverage so my experience is not generalisable (see how that’s done?). But with the exception of minor changes in coverage, it has been very stable for years now. I don’t profess to be an insurance intuit so I will refrain from guessing what will happen in the future.
[…] This is exactly the sort of disillusionment with science-based medicine that leads patients to quackery like naturopathy. I’ve heard the story again and again and again. Unfortunately, the current model of insurance-based reimbursement encourages—nay, demands—the sort of behavior that Hermes’ dermatologist exhibited. With reimbursement barely covering the cost of providing medical services, physicians find themselves forced to try to make a living on volume. It’s true for surgeons, but its especially true for primary care physicians. Spending 30-90 minutes per patient is a recipe for going out of business. Quacks like naturopaths, however, base their model on this. Indeed, as I discussed this very issue earlier this week when I discussed “integrative medicine” as the lure of the shaman-healer. […]
It’s one thing to integrate with a group’s traditional healers when that group is fairly new to modern medicine (good politics) like the people in the photo seem to be. They’ve no reason to trust the stranger and his odd ways. And maybe, just maybe, you can teach the traditional healer some modern things, if the two of you can build up a good relationship. However, Europeans’ traditional healers were by and large replaced with physicians centuries ago. Doctors are our traditional healers!
Our family has been poorly served by our physicians over the years, in many serious ways, resulting in much unnecessary suffering, some of which will never be overcome due to lasting neurological, other physiological, and psychological damage (lives derailed, many years of pain and illness, etc.). We are educated, proactive, intelligent, and have good (and very expensive) health care coverage. The maladies were easily discovered, obvious, and not rare. And further complications easily avoidable. In my opinion, the problem starts in medical school; there is an obvious deficit in diagnosis, including teaching how to piece together a puzzle, and a built-in skepticism of the patient. This speaks of an arrogance, and being taught to disrespect and disregard the observations of the patient or the parent (mother). It also speaks of constant haste and being overworked.
Physicians are also now between a rock and a hard place that started when the insurance companies became the middle man and took away their profits. Their incomes dropped, and along with that their political muscle, and their ability to self advocate as a group. They lost more and more income and the power to do anything about it. In order to support a practice they are forced to see many patients, quickly, and work long hours. Many cannot support their families on their incomes.
Then comes Obamacare, which has placed remaining profitable practices in the position of sharing their income with those that are unprofitable. This is socialism. I am the wife of a physician (a specialist), and his job has required both of us. We have worked very very hard all of our lives, and find that we are pretty much left stranded. We have our savings to rely on for retirement, but we need everything to raise our children. I try to explain to people that in order for a physician to be first rate, it takes two – his job is a two person job. I gave up my career for his. I recommend to physicians that they choose between their profession and having a family – it is practically untenable to attempt both.
Regarding the new quackery movement. I see friends go through all kinds of ridiculous exercises, and to no avail. Herbs and fake herbs are not the solution. I have been exploring the origins of a couple of herbs since learning of the recent testing of certain herbs in major chains, and most ingredients come from China, with a few exceptions. The supply chain is opaque, and there is no way to know the truth.
I am also concerned about the pharmaceutical industry and the cost of developing new drugs. Is the purpose of these mergers really just to enrich the top executive(s)?
Thanks for reading.