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.