How to woo away from woo?

It’s another head-meet-desk week over at the clinic.

Remember this woman? Well, she’s been on the bovine thyroid extract for a while now, and her thyroid functions – quelle surprise! – haven’t gotten any better. I haven’t yet managed to contact her about it, but maybe I can help her see that bovine thyroid extract with the thyroxine removed isn’t going to help her very much.

In a related matter, another patient of mine has been in the hospital for the past week with a severe gallbladder infection, in extreme pain, caused by gallstones obstructing her cystic duct and common hepatic duct. She is scheduled to undergo an ERCP to remove the stones, and then the surgeons can get to the business of removing her gallbladder. Which is what I suggested she do when her symptoms started 6 months ago and were nowhere near as bad as they are now. But she preferred to go to an iridologist, who claimed to have “melted” her gallstones via naturopathic treatments.

In case you were wondering, I don’t say “I told you so” in cases like this. I think this woman has more than learned her lesson. But when things like this happen (and they happen more often than you’d think), I always wonder if there was something I could have said, but didn’t, to convince patients at the time their condition is first diagnosed. Obviously, patients have autonomy and the right to choose whichever course of action they wish, but I hate to think that if only I had said X, done Y, explained Z…they would have been convinced and undergone the correct treatment on time.

Apparently, I’m not the only one wondering about this. Here’s an even more extreme case of a young woman who declined cancer treatment which would have most probably cured her in favor of alternative treatments – with entirely predictable (and very sad) results. I guess I’m lucky that all my patients so far, when faced with a diagnosis of cancer, realized that you can’t play around with it.

I also spent a good half hour this evening trying to convince another patient, this time a woman with rehumatoid arthritis, that stopping her medicines as suggested by her iridologist was a very bad idea. You can read about the fraud that is iridology at Quackwatch.

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9 Responses

  1. Oh, how frustrating! My mother-in-law got really interested in naturopathic remedies when she read “It’s All in Your Head: The link between mercury amalgams and illness” by Hal A. Huggins. I read about half of it and couldn’t believe that anyone would fall what he said because it was so ridiculous. She actually went to a naturopathic dentist who recommended chelation therapy. She did one session with him and felt so miserable that she decided to give it up. I was glad because she had been pushing me to only take my children to naturopathic physicians.

  2. This is a tough one. I was responding to a local discussion about vaccines when I came across an study from 1996 sited in Michael Fitzpatricks’s excellent “MMR and Autism” that found that the more evidence parents were are suspicious of vaccines were shown, the more entrenched their attitudes became.

    I think you just have to tell people the truth and suggest you help them monitor their progress. Most people are fairly pragmatic at the end of the day.

    The one thing I don’t think anyone should do is to try to frighten people. Fear is what leads people to woo in the first place . It’s tempting… “don’t worry about this worry about THAT.” In my experience though it usually backfires

  3. Lisa – your MIL was lucky. My great-aunt, who is heavily into woo, has had her teeth entirely de-amalgamized (is that a word? 😉 ) and has made some quack dentist very, very rich. I don’t know that she saw any improvement in her general condition beyond the placebo effect, either.

    Nancy – can you find the cite for me, please? That sounds like an interesting study.

  4. I just had my gallbladder removed and I finally feel great for the first time in a long time. The attacks were *very* painful, the worst I would put up there with going into labor. I cannot imagine extending this in the interest of a more natural approach. An armchair naturopath did do me the service of advising against eating foods from the nightshade family. I looked it up to see what that meant: no tomato, pepper, eggplant — I don’t think so. Just looking at the three of them together in a sentence makes me think of a potentially delicious dish.

  5. My pleasure

    Meszaros, et al (1996) ‘Cognitive proceses and the decisions of some parents to forego pertussus vaccination for their children’, ‘Journal of Clinical Epidemiology;49: 697-703

    You should check out MMR and Autism: What Parents Need to Know, by Michael Fitzpatick as well. It’s full of interesting things like that.

  6. I think part of the problem is that physicians can be very dismissive of all alternative/complementary treatments and do it in a way that’s extremely condescending, which is just likely to make the patient feel defensive.

    I attended a conference yesterday at a major cancer center in the U.S. discussing alternative treatments. There are good studies supporting the use of acupuncture and hypnosis for cancer-related pain and nausea, and dong quai, an herb widely used in Traditional Chinese Medicine, is being studied for its potential estrogen blocking ability (which means it could potentially be used to reduce the risk of breast cancer). Yet despite this scientific evidence, the majority of cancer doctors oppose the use of any alternative modalities.

    Yes, many alternative treatments are useless or even dangerous, but doctors should be open to the treatments that have good scientific support. And when their patients approach them about therapies, they need to be careful not to ridicule the patients or alternative providers. No one likes to be made to feel stupid.

  7. Interesting point Li. I think you are right that it’s important not to patronize. On the other hand, I wonder if the attraction to alternative medicine and therapies is really based on their efficacy?

    For instance, my son is allergic to eggs and milk. We see doctors at the Mt Sinai who are at the cutting edge of research into food allergies. It’s really exciting stuff. They have a ‘vaccine’ that appears to eliminate peanut allergies in rats and they are conducting trials on Chinese herbs that, when administered once or twice a year (I’m doing this from memory so I can’t guarantee I’ve got the details right) seems to prevent egg allergies and might work on others too.

    Now, if these herbs do make a difference, they will be probably be developed and refined as pharmaceuticals. But will the fact that they are derived from Chinese herbs make them more acceptable to people who like alternative medicine?

    I’m guessing ‘no’. It seems to me that the root of the popularity of alternative medicine is disenchantment with mainstream medicine and probably modernity itself. As long as it happens in a Yurt, it’s okay, but when it moves into a lab it loses some of its appeal.

    That’s a very difficult thing to confront. But I think doctors have a responsibility to not to rush to embrace it as I think some have done. (I had to leave my neighborhood to find someone who wasn’t gushing about how they were happy for their patients to use it.) Patients need doctors NOT to pander. That doesn’t mean it’s okay to treat people badly. As it happens thing that part could be exaggerated. Alternative medicine flourishes on the basis of it’s ‘persecution’

    In other words tell the truth. Say it may not do harm or it may – we simply don’t know. This is what we know about x. This is why it works, etc..

  8. As far as I’m concerned there is really no such thing as ‘alternative’ medicine’. There are treatments that have been proven to work, and treatments which haven’t been. But as long as the latter are used as complementary treatments and are not known to be harmful, or interact in a potentially harmful way with the proven treatments, I’m fairly tolerant of it ,though it makes me sad when I see patients who can barely feed their families spend large amounts of money on useless treatments.

    I draw the line when someone forgoes the effective treatment in favor of a useless one, though.

  9. Esther: It reminds me of phrenology. You know that old practice of feeling the bumps on someones head and telling them aobut their health. You can run into the phrenology heads in curiosity shops.

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