Health & wellness

In Practice

When patients choose alternative medicine

Dan Page

One afternoon, several years ago, I lay on a table in a scruffy little house and let a stranger stick needles into me.

I’d had back pain for quite a while and neither anti-inflammatories, muscle relaxants, a steroid injection, nor physical therapy had relieved it. I thought I’d give acupuncture a try. Why not? Many of my patients swear by the ancient practice.

The acupuncturist was a kind, soft-spoken man who worked barefoot. His office couldn’t have been more different from my own. Instead of fluorescent lights, chrome fixtures, and shiny linoleum, his office featured Tibetan wall hangings and smelled warmly of sandalwood incense. I nodded as he showed me a chart of the body’s “meridians,” lines of energy flow based, in part, on the rivers of China. Then he inserted needle after (yes, sterile) needle into my forehead, hands, and ankles.

When I left, carrying a brown bottle of “liver cleansing tincture,” I felt unusually relaxed. And, for the first time in months, my back didn’t hurt.

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That day, I joined the millions of Americans, roughly one third of us, who use alternative or complementary medicine. (“Alternative” means outside of and “complementary” means used in junction with traditional Western medicine, but since the distinction between the two has blurred somewhat in recent years, I’ll just use “alternative” here).

I also contributed to a multibillion dollar alternative medicine industry which is, for the most part, unregulated.

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Why had I done it? Surely my medical training, rooted in anatomy and physiology and the scientific method, should have prevented me from accepting a treatment based on the rivers of China or unmarked bottles of “tincture?” I turned to alternative medicine for the same reason many of my patients do: I wanted relief that Western medicine hadn’t offered.

Some of my colleagues might argue that the relief I found was illusory, a mere placebo effect. Placebo it may have been — illusory it was not. Many studies have shown that placebos work by altering brain chemistry. In one experiment, researchers applied “pain relief cream” and “inactive” cream” on different areas of subjects’ arms. Neither cream contained any pain reliever. An uncomfortably hot stimulus was then placed on both areas while the researchers imaged the subjects’ brains. When they exposed the areas with the “pain relief cream” to heat, the subjects’ brains released opioids, similar to narcotics like morphine.

In other words, when you believe that a treatment will relieve pain, your brain actually releases a powerful pain-relieving substance. Likely, my confidence in the kind acupuncturist, more than his placement of the needles, had alleviated my backache.

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I’ve often encouraged my patients’ use of alternative medicine. Sometimes, my enthusiasm derives from the fact that the patient has a problem — chronic back pain, headaches, or pelvic pain, to name three examples — that Western medicine frequently fails to resolve. Sometimes, even though I’ve seen studies demonstrating that a treatment is ineffective —saw palmetto for enlarged prostate and glucosamine chondroitin for arthritis, to name two — if it doesn’t cause any harm, I see no reason to tell a patient to stop using it if they find it helpful.

But when a patient pursues an alternative treatment that I feel might make them sick, or refuses conventional treatment because of an alternative theory, I feel very conflicted. On the one hand, I respect people’s right to do as they wish with their own bodies. On the other hand, my Hippocratic oath obliges me to “prescribe regimens for the good of my patients.” Recommending a therapy that I don’t feel will be beneficial, and may well be harmful, seems a violation of that oath.

Also, while I don’t subscribe to the old paternalistic view that the patient knows nothing and I know everything, I didn’t undertake years of intensive study and training in order to remain silent while my patient obtains bogus and potentially harmful medical advice from, say, the Internet.

This conflict arises every fall when the influenza vaccine is released. The flu shot is by no means 100 percent effective, or even 100 percent safe, but it does save thousands of lives each year, especially among pregnant women, the very young, and the very old. Many of my patients refuse the vaccine, saying that “it gives you the flu” (it doesn’t) or “the last time I got one I got sicker than ever” (coincidence) or, simply, “I don’t believe in it.”

Part of the flu vaccine’s bad rap stems from a belief among some alternative medicine proponents that all vaccines are dangerous, ineffective, and foisted on the public by a malevolent and greedy cabal of doctors, pharmaceutical companies, and the government. Recent outbreaks of preventable diseases such as measles and whooping cough attest to how injurious this belief can be.

Particularly challenging is the patient who pursues potentially harmful alternative treatment for a controversial diagnosis. Chronic Lyme disease, systemic candidiasis, and chronic fatigue syndrome are all diagnoses that haven’t been widely accepted by traditional Western doctors. While it’s clear that the people who feel they have these conditions are suffering, it’s not clear that Lyme, yeast, viruses, or other purported factors are responsible for that suffering. I once had a patient who believed she had chronic Lyme and sought alternative care when I would not prescribe the months or years of antibiotics she felt she needed and that I worried would harm her.

I liked my acupuncturist so much I took my mother to see him for the shoulder pain that had been nagging her for about a year. Acupuncture didn’t help her and — no fault of his — the shoulder pain turned out to be a warning sign of the heart attack she had not long after she lay on his table.

When a patient pursues an alternative treatment that I feel might make them sick, or refuses conventional treatment because of an alternative theory, I feel very conflicted.

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I never saw the acupuncturist again. I no longer believed he could help me, and therefore, he couldn’t. Which, come to think of it, is exactly how my patient who thought she had chronic Lyme disease felt about me.

Dr. Suzanne Koven is a primary care internist at Massachusetts General Hospital. Read her blog at www.boston
.com/inpractice.
She can be reached at inpracticemd@gmail.com.
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