Discussing the things that work and the things that don’t work

If you know me, you know that I’m a big proponent of evidence-based medicine. (Some are calling it “results-based” or “clinically significant” medicine.) There is nothing I despise more than charlatans who sell remedies that have been shown not to work. People who say that this or that is a cure for cancer and that “big pharma” doesn’t want to acknowledge that there is a cure for cancer… Those people annoy me and make me very, very angry.

I’m passionate about this subject because, in my personal and professional life, I have witnessed the harms brought to people who gravitated toward sham treatments instead of following their healthcare providers’ advice. I have seen what happens when someone with a treatable cancer decides to go the “natural” route and ends up in trouble, or dead. Someone sold them something that simply does not work, promising them that it does.

Are there natural alternatives to medication? Absolutely. There are many, many times when we take antibiotics for viral infections when staying home, resting and drinking a nice tea will do just as well. There are other times when we take painkillers when exercise and physical therapy will do wonders.

And that last part is the part that got my wife into a discussion with a friend the other day. She is a physician assistant. He is a medical doctor. She has worked for over eight years in family practice and urgent care. He has worked double that (and then some) in cancer care. Their discussion was about the use of “alternative medicine” (which is not medicine, in my opinion) for the treatment of fibromyalgia.

Depending on whom you ask, fibromyalgia is a physical manifestation of something real or something in the patient’s psyche. Either way, the true one cause is still unknown. But there is plenty of evidence that things like exercise and relaxation work. In some cases, these may work better than painkillers.

So my wife and my friend discussed (on Twitter of all places) where things like acupuncture fit into the equation of treating fibromyalgia. She contended that, yes, acupuncture doesn’t physically do anything, but the process of being treated with it is relaxing and may even trigger the placebo effect on a person with fibromyalgia — something that could be beneficial and effective. He contended that acupuncture relies on magical thinking for it to work, so it wouldn’t do any physical good to the person receiving it. So the person was better off seeking true medicine.

And, you know what? They were both right.

Yeah, I’d be a fool to go against my wife on anything, right? Not so. She is a very smart and rational woman. As long as I bring a reasonable argument, she will hear me out. So I’m with my friend in that acupuncture physically does absolutely nothing. If anything, it increases the risk of infections. (Have you seen anyone wearing gloves while doing it?) At the same time, I’m with my wife in that a psychogenic condition can be treated by manipulating the person’s perception of the world. Put a person exhibiting signs of pain from a psychological stress into a peaceful and relaxing situation, and I bet you anything that the pain goes away. It’s in maintaining that peace that the challenge comes.

I’m also with my wife in her assertion that narcotics for psychogenic pain are a bad, bad idea. We are seeing more and more evidence of people getting addicted to narcotics when regular non-steroidal anti-inflammatories (e.g. tylenol or motrin) or relaxing and exercising more often will do the trick. But it’s a tricky thing to discern whether pain is the manifestation of something wrong with the body or something awry in the mind.

It’s hard to be on any side on this because fibromyalgia is such a complex thing. There are other diseases and conditions that are just as difficult to deal with. I mean, look at the “controversy” of chronic Lyme disease. Lyme is caused by a bacterium that is susceptible to antibiotics, so it should be cleared reasonably quick. But there are people whose symptoms do not resolve right away and demand to be on prolonged antibiotics until the symptoms do clear up. For that, there is little evidence that the infection is active that long and that this effect is more a result of the “return to the mean” effect that we see in diseases all the time. It’s just that it takes some time for the effects of Lyme to go away. Or you can get reinfected if you live in a place where Lyme is endemic and the ticks that carry it come into contact with you time and again.

Nevertheless, I’m glad that this discussion happened. It was cordial. Although he’s known for his snark, my friend was not snarky. And my wife said she learned from the discussion. It was a win-win. I wish all conversations on controversial issues were the same.

I'm a doctoral candidate in the Doctor of Public Health program at the Johns Hopkins University Bloomberg School of Public Health. All opinions posted here are my own, of course, and they do not necessarily reflect the opinions of my school, employers, friends, family, etc. Feel free to follow me on Twitter: @EpiRen

One thought on “Discussing the things that work and the things that don’t work

  1. Funny, I just watched a discussion on the CDC website on Lyme disease.
    Apparently, DNA is cleared rather rapidly after antibiotics are used for primary stage Lyme, but proteins remain for a very long time.
    I was actually surprised that the body didn’t clear those foreign proteins. Still, there is no hint so far that the body reacts to those proteins.
    There is a significant suggestion that damage from secondary Lyme disease remains and can be chronic. But then, we’re talking arthritis and tissue damage.

    As for pain relief and its treatment, it is a daunting thing to treat chronic pain. Especially chronic pain from neurological damage. My wife and I are both chronic pain patients, both due to nerve injury secondary to degenerative disc disease. While the pain isn’t easily measured by instruments, nerve damage is.
    Remind me to tell you about the time my pain management physician didn’t like one professional’s electromyogram results, so he wanted to do the test himself. His office promptly overruled him and his partner repeated the test. He then complained and I acquiesced on one condition, that when he did me, I’d do him. He accepted the results.
    Though each professional was shocked at my tolerance to the nerve conduction study. But then, I have a high tolerance for pain and I’ve also been shocked hundreds of times when working in electronic device repair.
    The majority of the time, a bit of NSAID works. To be precise, I start each and every day with 600 mg of ibuprofen. For rare *really bad* days, a bit of codeine works.
    For my wife, her damage is more significant. And inoperable, due to osteoporosis. She’s taking hydrocodone for her pain. Minimal tolerance after decades of use, zero withdraw symptoms if she runs out if I forget to order it.
    That all said, psychological effects are significant. I’ve personally witnessed the placebo effect on trauma patients. I’ve noticed positive reinforcement impacting perceived pain in trauma patients. To say that the effect is astounding is an understatement.
    I recall a very old and dearly missed departed friend, my old family doctor. He was phenomenally good at tolerating an exceptionally bright child in his office, indeed, we literally discussed medicine at a rather in depth level.
    I recall a few things he had said that remain with me today. He remarked how he never cured any patient, he only bought time so that the patient’s body healed itself. He also remarked on the power of the mind. It could make one ill for no physiological cause. It could defeat pain in many cases. It could modulate healing, for the better or worse, depending on the outlook of the patient. It could even kill an already weakened individual, where others survived the same illness or injury.
    He as a cigar and pipe smoker. He also believed and preached moderation.
    He died of colon cancer. At age 98.
    He was the wisest man I have ever met.

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