Evidence-Base Medical Treatment

If you haven’t heard the term mentioned in the title, you may have heard of “Western Medicine” Vs “Eastern Medicine” or “Alternative Medicine.”  You have probably heard many, somewhat derogatory descriptions, of these philosophies from their opposing viewpoints.

Some people criticize “Western Medicine” for treating the disease rather than the whole person. On the other hand, some will criticize “Alternative Medicine” (also called CAM for complimentary and alternative medicine) as snake oil or fake treatments.

We are clinic based on the principles of Evidence-Based Medicine and I wanted to explain what we mean by that.  I am certainly supportive our our patients who want to see chiropractors, acupuncturists and naturopaths, especially if those things are helping and there has been at least some evidence that the things they are using are safe and helpful.

Evidence-Based Medicine, is as its name implies. It is medical care based on the science that proves that it is effective and safe. To prove that a therapy is effective you must compare it to a placebo in large numbers of people.

The reason for the placebo comparison is that we are all very susceptible to psychological factors. If you give someone a pill that is made of plain flour, but tell them that they will have fewer headaches if they took it every day, most of us would believe that we did have fewer headaches (whether we did or not).  On the other hand if you gave someone that same flour tablet and told them to look out for bad side effects (then list ten side effects by name) that most likely we would report those side effects. In the former case it is called the placebo effect and in the later case it is called the nocebo effect.

To prove that a therapy is more than just a placebo effect, it takes large numbers of study patients, usually more than a hundred, and more than a thousand is even better. Then you have to “double blind” the study so neither the researcher or the patient knows if they that the real treatment or the placebo.  Then there has to be a very careful diary kept to collect data. That data is analysed according to statistical methods, which rule out the probability of chance. Only then, do we know that something really works, and is safe.

One idea that is not accepted in Evidence-Based Medicine is the testimonial. While infomericals rely heavily on testimonials, it is a poor way to prove if somethings really works. Maybe one person did see their headaches improve after a particular therapy.  But they may have just been lucky, going through a natural improvement or, fallen for the placebo effect. Of course, the ones on the infomericals are being paid handsomely for saying something works. But maybe the next one hundred people see no improvement.

As I said above, I encourage my patients to seek care, simultaneously, with  CAM therapists. There is evidence within our Evidence-Based Medicine model that things like supplements (but only four to date have been studied) and acupuncture is helpful.  I also like their emphasis on treating the whole person. However, there are times that following with some CAM therapists is counterproductive.

Some CAM therapists explain headache problems with very simple explanations.  For example, you have headaches because your cranial bones or your atlas neck bone has moved. Another one is that you have headaches because of toxins in your colon. There is no evidence for us with the scientific model that these things are even possible. But patients loose trust in us when our answers are really complex, having to do with genetics and the influence of genes on calcium channels in neurons of the brain stem and Trigeminal Nerve (as just one example) and then they hear these very simple and attractive (because these things are supposedly fixable) explanations.

The other time that CAM therapy interferes with patients getting better is when the patient is told by the CAM therapist that we use un-natural chemicals (medications) and they only use natural treatments.  I could write a book on that issue alone, but I oppose that contrast. A lot that thinking is rooted in the likes of the French Philosopher Jean-Jacques Rousseau, who proposed that pure nature is always good and better than nature that has been tampered with by humans. Madison Avenue has exploited that belief with constant marketing on “natural” Vs “chemical.”  To a scientist, that division makes no sense.  Many things in Nature are extremely dangerous, can cause cancer (tobacco is one example) or poison you (such as natural heavy metals).  So-called “chemicals” or medications have revolutionized our way of life . . . for the better. We live to 75 years old rather than 35 years old because of these “chemicals.”  We have a much better quality of life also due to medications.

Another point is virtually all of our medications start with plant, animal or bacterial products that are then purified and altered to make them safer and more effective.  One example is the medication that we use called dihydroergotamine. It is an extremely effective migraine stopping medication. It is found naturally in a fungus. However, after growing the fungus in the lab, the extracts have to be purified and altered, if not, they are virtually poisonous.

So, my main point in this posting is to explain that the reason that we do the things we do is because we are committed to working from the paradigm of truth, which we believe comes from scientific evidence. Patients are welcome to explore these other avenues, but the reason we don’t explain things from these simple models isn’t that we are dumb or that we don’t care.  For example, we don’t routinely do neck x rays because we think it is a waste of money. In our opinions, based on the evidence, it is extremely rare that something could show up on a neck x ray that would be causing headaches.   However, speaking humbly, I know that the next great advance in headache care might come from a supplement, or acupuncture technique.  I do listen to my patients and learn from them every day.