Rrriiiiight……Or Born (again) Skeptic

When I started medical school I considered myself to be a fairly open-minded individual as far as alternative medicine was concerned. After all, I had spent a year or so teaching yoga and meditation and was an active, if discerning, consumer of a few supplements and herbal medications. Basically, as far as alternative medicine was concerned, if people wanted to give it a try and it works for them, why not?

I realized today that apparently, that has changed. We had a few lectures by alternative medicine providers this afternoon, presumably to broaden our horizons and open us to the idea of collaborating such practitioners. Well that backfired spectacularly.

One of the speakers was a local chiropractor, who demonstrated a few cringe-inducing adjustments on a numb-looking patient, and proceeded to explain some basics of chiropractic practice and philosophy. It was all sounding quite reasonable and benign until one of my classmates piped up with a question about vaccines. As in, do you advise your patients against vaccinating their children. DUH Duh duuuuuuuuhhhhhh.

The chiropractor earnestly explained that they advise patients to research both sides of the vaccine debate, providing “resources” from pro- and anti-vaccine organizations, and make their own decision. Personally, they further explained, they no longer believe in vaccines, do not have their own children vaccinated, and just don’t understand why some pediatrician’s are now choosing to turn away unvaccinated patients. At which point most of us either A) Started tuning him out completely or B) Subsequently just heard something like “Quack, quack, quack, quack……” every time he opened his mouth.

Personally, I was shocked by his admission, and I was shocked by my reaction. I honestly felt he had completely discredited himself and was loath to believe anything else he said. I was also surprised my reaction to the debate that followed about pediatricians turning away patients. I do not believe in turning away patients. For any reason. But now, I understand why these physicians do.

I realized, I am going to be a doctor. I have spent the last three years of my life living, breathing, eating, sleeping, and having the gospel of Evidence Based Medicine pounded into me, seared into my very soul. I am now a convert, a devotee to Religion of Research and I live by the tenets of well-designed, double-blinded, randomized, internally valid, high-powered results. With a reasonable confidence interval. Naturally. And if you are going to try to sell me some treatment for my patients, you had better have some d*mn good, rock solid studies to back it up.

Everything else the guy said, all the previously fairly reasonable sounding (non-cited) information he had been imparting, suddenly seemed completely hokey. As did pretty much everything coming from the Oriental Medicine Practitioner/Acupuncturist that followed. In full skeptic-mode I noted that neither of them appeared to have hard numbers or patently reputable research in their presentations. Neither had the requisite Reference slide punctuating their presentations.

And now I’m left to think hard about my previous, “Sure, I’d be okay with one of my patients trying out a CAM if they wanted and if it sounded fairly reasonable,” stance. Because now two of the most popular CAM options in our society don’t sound all that reasonable to me all. They sound like they are rooted in rationales of “because the Chinese have been practicing it for thousands of years, so it should be fine” or “because [shrug] it seems like it gives some people relief from (insert random complaint here) when we apply violent pressure to their joints, and Hey! we really don’t appear to cause that many to stroke out when we do it!”

This is not acceptable. It’s against my religion.

The chiropractor did helpfully point out that his malpractice insurance is less annually than his car insurance bill. More proof that chiropractors can’t be doing that much harm. Right?

Frankly, maybe our higher (sometimes completely ridiculously so, says the future OB/GYN) Allopathic malpractice rates are a good thing in a way. In the way that it forces us to base our practice, the treatments we perpetuate on our patients, on hard science. We don’t do things to people just because its been done for thousands of years or because it ‘seems’ to work. As disciples of Evidence Based Medicine we only do things that have been proven to be effective by actual, quality, extensive research. At least we had better, unless we want to risk a patient’s life and a good old-fashioned shunning.

I am, in no way, saying that Allopathic medicine is infallible or without risks and poor outcomes. Of course not, I’ve seen the studies. I’m just saying we do our best, with all the hard research we can, to offset and avoid harm to patients. I still, also, absolutely believe in a patient’s right to choose. Patient’s can do whatever they darn well please, but if they ask me, as a person who values their health and well-being above all things, I solemnly swear on a stack of JAMAs and NEJMs, I’m not going to advocate for any treatment when I can’t clearly define the risks and benefits for them.