Ranting to /dev/null

Holy crap Ryan, that was amazing. You seriously need to post more stuff like this. I mean, you've got a real gift for abstraction and for very clear and concise writing, so taking hardcore medical stuff and distilling into into a coherent, just-deep-enough to really educate essay is something you GOTTA keep doing.

Here's something you might like: so you know how you and I both share the belief that wacky uber-leftist only exist say, economically and politically, because of the hard work done by the very people they attack? To put it another way, America is so filthy stinking rich that wacky "Fifth Estate" bums can live off the ample crumbs of the society to give it crap (often times, quite literally, leeching of their parents for example).

Well, I'm wondering how applicable this type of analysis can be applied to the current debate between traditional medicine and the homeopathy "alternative" medicine nuts. As in, its only because traditional medicine has gotten our society so damn healthy, and has gotten so damn thorough at stopping so damn many diseases and infections, that people are healthy enough to "attack" traditional medicine and claim the virtues and sucesses of "alternative" medicine, like accupuncture and other stuff.

I'm not even saying that these folks are necessarily wrong, or that there isn't some kindof virtue to accupuncture (or radical critiques of capitalism, for that matter), its just that what they fail to realize is that they wouldn't even be able to offer their "alternatives" without traditional medicine.

Oh well, just some thoughts. You're soon to be the expert.

Ryan-
Very interesting. I'm particularly struck by the fact that some diseases don't kill you before "old age." Where does "old age" fit into this taxonomy? I suppose it is a disease that will "kill you every time." This might go beyond the pale of M1, but I bet that won't stop you.

Josiah-
Is there something inherently wrong with being critical of those who made your existence possible, or are you targeting the general lack of understanding/recognition that you are "biting the hand that feeds you"?

Not sure that my question makes sense; here's a positive assertion:

To put it personally, its ok to criticize my father (who I'm "leeching of off" in more ways than I'll ever understand) so long as I understand that a lot of what I have comes from him, and I am aware of that dynamic, as much as is possible.

What do you think?

I see what you're getting at, but I think the situation is different here. In the case of the moonbats, they're a product of the system they dislike, and wind up trying to cut off the branch they're sitting on.

Homeopathic and alternative medicine are frequently rejections of modern developments rather than unintended products of them. Heck, digitalis (a drug critical for controlling cardiac arrythmia) is from foxglove and the first antibiotics were gathered as byproducts of mold, so the idea of "natural" remedies to diseases isn't inherently problematic.

Homeopathy and other alternatives generally fall into two categories: traditional remedies of varying levels of efficacy (acupucture really does do something, but no one's sure exactly what, and many other traditional remedies are merely simple forms of well-documented ways to relieve symptoms), or ignorance combined with bad science (99% of herbal supplements, every diet pill you care to name, and anyone who thinks that magnetism can do things for your health). The main criticisms of modern medicine have a lot more to do with the way medicine is practiced than the actual science itself. Most people don't understand that what an antibiotic does is chemically interfere with the ability of a bacterium to form a cell wall, thereby causing it to either break apart, or be vulnerable to attack from the immune system. All most people know is that the doctor gives you a pill and tells you to take it three times a day until it's gone. Why should one pill be better than another? Proponants of herbal remedies assume the language of scientific inquiry and use it like magical words of power to validate their crackpot theories.

Take garlic for example. Supposed to be good for your heart and blood pressure, right? Think about this for a minute. Do you think for one second that if garlic did half the things it's claimed to do that every cardiologist in the country wouldn't prescribe it constantly? I mean, if the claims are true, then we've got a really cheap way of regulating a host of chronic and expensive cardica problems. But physicians don't prescribe garlic. Why not? Because there isn't any reason to believe that it does anything. Same goes for St. John's wort, excessive amounts of vitamin C (actually that does do something: it's toxic), nor ginseng. Or, at least, there has been no rigorous clinical test in which any clear benefits have been proven. But if you don't understand how real drugs do work, you won't understand why bogus "drugs" don't work.

Moonbats have a certain degree of intellectual respectibility, and it's well documented that the higher your level of education, the more liberal you tend to be (though how you can be that well educated and still be so stupid is beyond me). Proponants of alternative medicine are, in my experience, extremely ignorant of things like chemistry, biology, physiology, and the scientific method. Just like we all were five hundred years ago. Education can cure one of relying overly much on herbal magic, as the root problem is ignorance. Being a moonbat is - at its best - the result of a genuine intellectual difference of opinion. Whatever Howard Dean may be, he isn't dumb or uneducated.

To sum that up: the loony-left is the current manifestation of a centuries long intellectual discussion about politics, economics, and morality. Moonbats may be irrational in their expressions and arguments, but they're merely an extreme species of genuine leftists (though there aren't many of those still around). Herbal and alternative medicine is taking the losing side of a discussion that was settled pretty soundly a few centuries ago. We stopped doing alchemy in the Renaissance, but just because the scientific community knows better by now doesn't change the fact that the average joe on the street is as smart as two sacks of bricks.

That was really, really interesting. You're a skilled popularizer. Keep writing this sort of thing.

Josiah and Ryan,
Just to salvage a little bit of respect for alternative medicine...
I won't try to defend all the quack treatments or ignorant people assuming a physician's role, but after doing an EMT internship and being around my mom through her cancer treatments, I got a pretty good feel for how hospitals really operate, and I came to appreciate some aspects of the alternative approach a lot more. Alternative medicine's fundamental critique against modern medicine is that most doctors tend to treat patients like machines who don't need fixin' if they ain't broke. Aside from the question of whether it's even appropriate to view the human body as a kind of machine, the holistic attention that natural physicians give to patients(who, by modern clinical standards, are completely healthy) is an extremely valuable aspect of patient care which, in general patient-doctor interactions, rarely enters into the picture.

Jeff-

Ah, but that's a whole different kettle of fish. If it's human compassion and bedside manner, I'm all for reform and new understandings. There is a really significant relationship between one's person and one's body that modern science has absolutely no category for. But this isn't really "alternative" medicine in that it isn't actually offering anything that "normal" allopathic medicine can't.

The times when most people turn to "alternative" medicine is when normal scientific medicine isn't giving them the relief they want. Sometimes this is because they've been told that there isn't anything wrong with them, even though they're experiencing discomfort. The fact of the matter is, there may not be anything "wrong" with them medically. I believe that emotional and inter-personal conflict can result in physical symptoms far more often than is normally allowed for by most physicians. I believe that treating patients as people instead of bodies is essential to proper care. I also believe that the connection between the physical problem and the symptoms it produces is not always discernable. But most of all, I believe that many people who are experiencing discomfort who do not have any officially recognized disease are basically living unhealthy lives, whether that be emotionally, nutritionally, relationally, or behaviorally. You work yourself too hard, you can get an ulcer. Yes, scientists try to come up with a physical causal route for that, but I'm willing to believe that the mind affects the body in ways that are altogether counterintuitive. You carry around a lot of baggage, and your soul is going to take it out on your body until you do something about it.

All that by way of saying that I don't believe that standard allopathic, scientific medicine is the sum of all health-related problems. The absence of disease is not necessarily the presence of health. But, and I will stick with this one, if anyone - I don't care who - wants to claim that a given substance or treatment produces a physical, clinical difference in the human body, this is an empirical, chemical, and biological question. I'm perfectly willing to entertain the suggestion that compassionate care produces a positive psychological response which can have far-reaching and poorly-understood physiological effects. "I don't know how this works or what it does, but it's doing something and it seems to be good" is a response I am okay with. But if you want to make a claim to the effect that garlic alleviates hypertension or that any of the umpty-billion herbal supplements do a blessed thing that can't be accounted for with placebos, show me the data or get stuffed.

My stars, the scientific method alive, well, and applied by someone I know and love in a healthy fashion! "Show me the data", he says! My cynicism as regards the death of the sincere intellectual is melting away!

PS: my mom's an RN, and a fantastic one at that. I can't decide whether it's intuitive mom-ism or long-practiced healthcare, but any bellyache I ever have is quickly cured by her swift diagnosis and consequent clucking.
Gotta love the medics who'll recognize that emotional-physiological connection. Ryan, you'll literally be a godsend in medical practice.

Cheers, buddy.

thanks for your entry. I say bring on more.

my 1 cent on the alternative issue:
in my experience, most of the practitioners of modern medicine simply dont know what to do with folks who dont clearly have something specific "wrong" with them. they tend to get frustrated, accuse you of being depressed (thereby making you someone else's problem) or perhaps just do their thing and hope it works (which is no small matter when you're dealing with back surgeons and such). the arrogance is often palpable. no wonder many of us run to the alternatives. fortunately, there are a few MDs out there restoring my faith, but honestly, I trust our chiropractor more than 95% of the doctors we've seen, mostly b/c he cares.

if I may: for the good of your cause, do your best to stay humble.

Bobw -
I'm becoming more and more convinced that the source of most symptoms really isn't physical. Allopathic medicine doesn't really know what to do with this, but highly trained professionals (doctors being some of the most highly skilled people in the world) don't like admitting that they're reached the end of their field.

It's psychosomatic. Which isn't to say that you're crazy or that whatever it is doesn't hurt. It's to say that something's bothering you and you should deal with it, and mucking about with your spinal column isn't the solution. Find someone to talk to. Learn about yourself and the things that bother you. This is what a good physician will do when he finds that the body is essentially healthy but the patient complains of symptoms. Do you know what percentage of the people that come into an emergency room actually have an emergent medical probem? Very few. I'd guess 25%. The rest of them just need some attention and compassion, and they'll be fine (or they don't have health insurance and can't get care any other way, but that is an entirely different story). A good doctor recognizes this and takes care of his people. Take some vitals, check them out, hear their story, calm their fears, and send them on their way. All most people are looking for is a chance to be heard. A bad doctor just turns people away, and when patients have this happen to them they'll look for someone who doesn't mind taking their money.

But as far as chiropractic goes: that stuff definitely does fall in the quack science department. The founder was a "spiritual healer" who played around with magnets and the like. Absolutely no evidence to suggest that chiropractic does anything good for anyone. Do you know why physicians can refer patients to chiropractors? It isn't because there's any good, demonstrable reason to think that it'll do any good, it's because in 1987 a chiropractor successfully sued the AMA and the judge ordered the AMA to reverse its century-old policy that referring patients to chiropractors is unethical. Sure, lots of people report good results, and lots of people swear by their chiropractor. That's because there almost certainly wasn't anything physically wrong in the first place that a decent massage can't solve, so a little TLC is what you really need.

The foundation of chiropractic medicine is the "subluxation", which while generally conceived of as some kind of misalignment in the spinal column, was originally used to refer to an abberation in the body's "innate intelligence" or "energy". Yeah. That's right. When X-rays are taken of a spine that allegedly is suffering from a subluxation, no two chiropractors are able to uniformly identify the problem. Why? Because the spine is normal, that's why.

You want someone to extend some compassion and concern for you, go see a massage therepist. They do good work. You'll feel better. Even better, find a friend and work through some issues.

You know how many treatments come in a normal chiropractic course of treatment? About 14. Know why? That's how many the Mediplans (and thus private insurance) will pay for. Has nothing to do with your spine or even your body, because there wasn't anything really wrong to begin with. Has everything to do with the quacks getting their money.

But your spine is fine the way it is. Leave it alone.

while I appreciate your concern, you are creeping into that arrogance I tried to warn you about :-) stop assuming I've got issues. I'm not saying that I dont have issues, but in this case, you're wrong. a little humility goes a long way.

my wife's the one with all the crazy problems I'm vaguely referring to. she happens to have fibormyalgia, which is a case of worms in itself. but the bottom line is that her chiro was the one who helped us figure out that's what she has, mostly b/c he cared enough to take the time to try to figure out why she wasnt getting better. now she's doing a safe, effective treatment that's on the fringes of "regular" medicine (using a lovely side effect of guaifenisen, which you of course know is an expectorant...long story...see guaidoc.com for more).

anyway, I know that many if not most chiros are quacks. but not all. bottom line: it works. of course our chiro does massage and he's also a nutritionist, so it's not just spine stuff. personally I've only been a few times, but the wife goes a ton, and as she's got a chronic condition, the adjustments and massage and stim certainly help keep her on her feet.

an aside: I've always been skeptical of the magnet craze. but a friend-of-a-friend, who is a large animal vet, swears by them for his horses old knees and whatnot. this old country boy now swears by them, figuring the placebo effect wouldnt work on a horse.

all that to say, I'm all for scientific proof and all that jazz, but dang, the human body and spirit are so complex that there's no way to know it all, right? I would hope that the more you know, the more you know that you dont know much, ya know?

One last comment before I move on: fibromyalgia is so ambiguously defined that calling it a disease is really stretching things. The word just means "muscle pain". There are a few theories as to the origin of the collection of symptoms that patients diagnosed as having fibromyalgia present with, but none of the theories can explain all of the symptoms. In short: there is at the present time no good explanation for the symptoms. Which, to me, suggests that it probably has a lot more to do with lifestyle and psychology than anything else.

And as far as "bottom line: it works", of course it does. The question is exactly what it's doing. Is it treating an identifiable physical problem with well-demonstrated clinical techniques? No. No it isn't. It's generally treating a vague collection of symptoms with an equally vague series of treatments that makes people feel better. Which fits fibrmyalgia to a tee. We've got no idea what it is, much less what's causing it, so heck, wave a dead chicken if that helps you feel better. It's not like there's anything better for it. Chiropractic "works" largely because someone took the time to take the patient seriously. If more MDs took their patients seriously, there wouldn't be any need for chiropractic.

actually, if you visit guaidoc.com that dude thinks he's figured out fibro, and yes, it's a misnomer. he's an MD, cares about people, got lucky, does his research, and figured out the somewhat weird yet effective protocol for treatment. you really do owe it to yourself and your future patients to check it out. but wait, there's more: unlike many others, the good doctor has essentially no financial incentive to convince you that his treatment works.

fibro is weird thing indeed. a "regular" doctor's nightmare and/or catchall diagnosis. hopefully someday the guaidoc.com guy will get enough funding to do an "approved" study so the word will spread. unfortunately, there's so little money in selling guai that it might not happen anytime soon. and vioxx and whatever else will keep flying off the shelves.

email me if you'd like a brief layman's summary of the lowdown. it's cheap, safe, effective, but complex and quite slow. and it's really given us back our life. if you want to chalk it all up to "lifestyle and psychology" I'll gladly throttle you with a textbook of your choice. :-)

take care.

That was a great post. Different from your usual fare, but in a good way. I hope to be able to write like you in the future.

Ryan, this is endlessly fascinating. If I ever get a book contract, I'm putting you on the payroll as my medical consultant -- even if I'm writing about walruses or something. I'd ask you to do the same for me, but you don't need any help with the writing.

Would you mind defining "allopathic" for me, especially as opposed to "homeopathic"? I think I'd better understand the debate between the medical profession and alt-medders if those terms were clearly defined for me. I side with the institutional, scientic community -- hey, I sort of worked in it for two years, and I've even gotten into some heated arguments over the stupidity of quack perinatology -- but I'd like to start getting a broader grasp on the debate. All I know about is making babies. (Ahem.)

You forgot to mention one very common cause of organ failure, especially in older patients. Over medication.