Alternative medicine: under the microscope

Natural Health, Sept-Oct, 1998

But one has to ask what value to society or to the person would be lost if any of these didn't exist. That's the more pertinent question to ask. There are 150 different alternatives; none of them seems to be consistent with any of the others. If one didn't exist, why not try another? There's no necessity for any of them to exist.

There is, however, a necessity for scientifically derived medicine to exist because that's what's been responsible for our advance in medicine.

Mehl-Madrona: I would answer that question by saying that I listen to what the patient wants because the patient can be right. Let's take the woman who goes to her obstetrician, family doctor, or midwife and says, "I don't want to have a fetal monitor during labor. I want to have a human being listening to my baby with a stethoscope." In almost every hospital in this country she would be told, "No, that's not allowed." However, there have been large randomized controlled trials which show that a nurse listening with a stethoscope is actually better than a fetal monitor and the incidence of damage from birth asphyxia is greater with fetal monitoring than with a nurse listening with a stethoscope.

Or take antibiotics. In this country antibiotics are used across the board for children with ear infections. But huge randomized, controlled trials have shown that they add almost nothing to the therapy. And yet parents are criticized if they don't give the children antibiotics for ear infections.

My point is that sometimes consumers are right. Our role as physicians should be to educate patients so that they can make the right decisions. But we must listen to them, especially in light of the fact that we're sometimes not sure what to do.

Consider the situation that happened to me last night. I had a patient with a deep laceration. Do I give him a one-time dose of IV antibiotic or not? Well, the studies are conflicting. Some suggest that that would set him up for a more serious infection, if he were to get an infection; a couple suggest that it would prevent infection; and a couple say that it doesn't matter at all. So what do I do? I tell him, "Here's what all the studies show and I really don't know what is the right thing to do. But I'll leave it up to you. What do you think we ought to do?" He said, "If you give me the antibiotic, I believe it will prevent me from getting an infection, so why don't you give me the antibiotic." I said, "Okay, fine. You need to know that there's some risk of allergic reaction and there's even a slight risk of anaphylaxis and death from an antibiotic." He said, "Give me the antibiotic."

I believe that's how we should practice medicine. Patients should decide what will happen to them. And we as physicians should present to them in an honest way what we know about what they want to do.

As physicians, we're in a unique position to evaluate evidence. But five physicians might make five different conclusions based on that evidence. So the way I see the job of the physician is very different from the way Dr. Sampson sees it. I think our job is to educate our patients to make good choices.