"Alternative" medicines are safe...right?

[WilcoWorld]

I live in a rather "progressive" area, and as such, there are a lot of folks around here who are into "alternative" medicine. This even includes a few colleagues. Personally, I find things like yoga, massage and the like just fine, but I start to get angry when people say things like "don't take drugs for your fever, take this tree bark" not realizing that tree bark is just an impure drug at an unknown concentration and of dubious efficacy.

To highlight this, I'd like us to share some of the cases we've seen related to these "safe" "alternative" therapies. On my last shift I saw:

20's yo female with a potassium of 2.1 and a heart rate of 150 whose only identifiable inciting factor was an herbal supplement she'd been taking for a month. She couldn't remember the name of the substance.

60's yo male who had acupuncture 2 weeks ago with gradually worsening neck pain and then developed a fever and was found to have cervical osteomyelitis/discitis!

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[Rendar5]

I live in a rather "progressive" area, and as such, there are a lot of folks around here who are into "alternative" medicine. This even includes a few colleagues. Personally, I find things like yoga, massage and the like just fine, but I start to get angry when people say things like "don't take drugs for your fever, take this tree bark" not realizing that tree bark is just an impure drug at an unknown concentration and of dubious efficacy.

To highlight this, I'd like us to share some of the cases we've seen related to these "safe" "alternative" therapies. On my last shift I saw:

20's yo female with a potassium of 2.1 and a heart rate of 150 whose only identifiable inciting factor was an herbal supplement she'd been taking for a month. She couldn't remember the name of the substance.

60's yo male who had acupuncture 2 weeks ago with gradually worsening neck pain and then developed a fever and was found to have cervical osteomyelitis/discitis!

though i have to ask, what was the guy getting the acupuncture for originally?

 

[DeadCactus]

So then do you make an effort to guide patients to safer resources for alternative medicines?

 

[Indryd]

So then do you make an effort to guide patients to safer resources for alternative medicines?

 

[deleted65604]

I saw a kid in the PICU with full blown tetanus, lock-jaw, opisthotonus. His parents had been giving him lobelia for a couple of days as the symptoms were starting out. His parents were organic farmers and didn't believe in vaccinations.

 

[tkim]

Year ago saw a breastfeeding mom with mastitis who declined abx. I told her she could paint her nipples with Gentian violet and continue breatfeeding with variable results. When she heard that she was uber thrilled that she didn't need to take abx.

She probably still has mastitis ... and purple nipples.

 

[WilcoWorld]

Rendar - I'd like to tell you, but to do so would make the case pretty identifieable, and thus violate privacy laws.

Deadcactus - No, I don't. In fact, I'm not sure that I could, given that these treatments are largely unregulated and often untested. But if you know of evidence-based, quality-controlled resources I'd be open to listening to what you have to say.

 

[WilcoWorld]

I saw a kid in the PICU with full blown tetanus, lock-jaw, opisthotonus. His parents had been giving him lobelia for a couple of days as the symptoms were starting out. His parents were organic farmers and didn't believe in vaccinations.

This case raises some interesting ethical questions. Were these parents guilty of neglect? Would they have the right to refuse treatment for their child's tetanus?

 

[Khaos]

No, they do not have the right to refuse treatment for their child. This has been brought to court many times and every time it has been rule for the safety of the child...no matter what reason the parents have such as religion or others...I don't believe these parents are found neglectful, just religious zealots most of the time.

 

[DeadCactus]

Deadcactus - No, I don't. In fact, I'm not sure that I could, given that these treatments are largely unregulated and often untested. But if you know of evidence-based, quality-controlled resources I'd be open to listening to what you have to say.

I'm not trying to defend the efficacy of any of these treatments. Most have no evidence-based justification and probably will never have any thorough clinical investigation (partly for lack of merit and partly for lack of profitability).

But patients are still going to turn to them. Why not re-iterate the lack of proven efficacy and then point them to an acupuncturist who at least uses sterile needles, a chiropractor not trying to cure cancer with spinal manipulation, etc?

 

[WilcoWorld]

I'm not trying to defend the efficacy of any of these treatments. Most have no evidence-based justification and probably will never have any thorough clinical investigation (partly for lack of merit and partly for lack of profitability).

But patients are still going to turn to them. Why not re-iterate the lack of proven efficacy and then point them to an acupuncturist who at least uses sterile needles, a chiropractor not trying to cure cancer with spinal manipulation, etc?

Because "most have no evidence-based justification and probably will never have any thorough clinical investigation".

Hopefully that comes across as I mean it (funny) and not as I don't (jerky).

 

[Pharmavixen]

Alternative therapies that turn out to work aren't alternative anymore - they're medicine.

Here's my favourite site for info on alternative medicine/quackery/vaccine hysteria/etc.

 

[DeadCactus]

My point is simply that patients will always dive into things that go against our recommendations for their health. Doesn't it make it all the more important for physicians to mitigate the potential harm?

Junkies should quit, but it's certainly a lot better if they at least use clean needles and you can point them to a resource for attaining them.

A patient is better off on lovastatin than red yeast extract, but he's better off taking red yeast extract under the eye of a physician than just buying it off the internet with no medical follow-up.

We can argue the efficacy of chiropractors, but I think it's fair to say that a patient is better of being referred to a chiropractor known and trusted by the physician to treat lower back pain than being left to wander into the office of back-quack that thinks he's a capable primary care physician.

Yes, there is a lot of unproven and worthless alternative medicine. But it seems like it would be better to reiterate the lack of documented efficacy and then guide patients to benign sources of alternative medicine than to completely ignore their desire and let them loose to be taken advantage of by out-right deceitful, malicious, and incompetent sources of alternative medicine...

 

[deleted109597]

Junkies should quit, but it's certainly a lot better if they at least use clean needles and you can point them to a resource for attaining them.

I can't, because I don't know a source in this town.

A patient is better off on lovastatin than red yeast extract, but he's better off taking red yeast extract under the eye of a physician than just buying it off the internet with no medical follow-up.

Actually they're probably about the same, with almost zero benefit. NNT for statins is close to 200 over 5 years. Yeah, it may make their LDL lower, but it doesn't stop heart attacks.

We can argue the efficacy of chiropractors, but I think it's fair to say that a patient is better of being referred to a chiropractor known and trusted by the physician to treat lower back pain than being left to wander into the office of back-quack that thinks he's a capable primary care physician.

I don't know and trust any chiropractors, as all the ones here that advertise make claims about curing allergies with spinal manipulation. So can't help there either.

Yes, there is a lot of unproven and worthless alternative medicine. But it seems like it would be better to reiterate the lack of documented efficacy and then guide patients to benign sources of alternative medicine than to completely ignore their desire and let them loose to be taken advantage of by out-right deceitful, malicious, and incompetent sources of alternative medicine...

All alternative medicine is deceitful. So steering them to something that at least isn't bad is like arguing that we should give antibiotics to strep throat because it likely won't help them, but will only hurt them a little. What we need to to is make a stand and tell our patients that they are hurting themselves, and the only good way is by being blunt. Another analogy would be like offering praise to someone because they cut back from 2 packs per day to 1 pack per day. You shouldn't praise that. You should tell them to quit. And if they don't like it, another doctor shouldn't be there to stroke their ego.

 

[docB]

I don't try to refer people to safer alt med modalities. I do frequently tell them that they need to read the labels on the things they take. There have been a lot of alt med preparations that highlight some herbal thing but also contain a plain old otc drug. Good examples include pills that say melatonin in big letters on the front but have diphenhydramine buried in the ingredients. Yeah it'll help you sleep, but it's not why you think.

There used to be some "memory enhancers" that talked up their ginko biloba and had pseudoephedrine. Sure you feel clearer and like you have more energy. Those went away when you started having to sign for them.

 

[DrArete]

I live in a rather "progressive" area, and as such, there are a lot of folks around here who are into "alternative" medicine. This even includes a few colleagues. Personally, I find things like yoga, massage and the like just fine, but I start to get angry when people say things like "don't take drugs for your fever, take this tree bark" not realizing that tree bark is just an impure drug at an unknown concentration and of dubious efficacy.

To highlight this, I'd like us to share some of the cases we've seen related to these "safe" "alternative" therapies. On my last shift I saw:

20's yo female with a potassium of 2.1 and a heart rate of 150 whose only identifiable inciting factor was an herbal supplement she'd been taking for a month. She couldn't remember the name of the substance.

60's yo male who had acupuncture 2 weeks ago with gradually worsening neck pain and then developed a fever and was found to have cervical osteomyelitis/discitis!

 

[Groove]

though i have to ask, what was the guy getting the acupuncture for originally?

And more importantly...how deep did they stick the needles?

 

[K31]

And more importantly...how deep did they stick the needles?

Sometimes deeper than they should, apparently.