Alternative Medicine and the Great Pharmaceutical Conspiracy

I am, in my heart, a skeptic.

That is to say, I don't tend to form opinions about things before researching them, and I can recognize real research as opposed to the biased stuff.

However, I believe in the power of yoga, massage, and tai chi to improve health, because I understand that such things are relaxing and good for the muscles, and relaxation improves health. I believe herbal remedies often work very well, because honestly, almost every medication we have today was derived from some form of plant or animal product that someone, somewhere, probably used to heal patients. Of course, they're way more useful, potent, and free of toxins in the refined form. I think DOs are a perfectly acceptable alternative to MDs and I would go to a licensed chiropractor for joint and back pain that did not respond to painkillers (though not for anything else).

So when I say I am a skeptic, I'm not the kind of person who thinks that all alternative therapies should be outlawed, or that any therapy that has not yet been tested in clinical trials must be completely useless. The truth is, clinical trials take time and money. Pharmaceutical companies can ensure that they have the safest and most effective product by charging high rates for their medications and trying those medications out on anyone who will volunteer or accept payment for it. It's usually many many years after the invention of a product that doctors even start hearing about it, much less the general public (the exception being new drugs that might cure some horrible and incurable disease, like cancer or AIDs, which the media loves even though it seems like 80% of them turn out to be dead ends).

Meanwhile, "alternative" medicine's inventors and promoters usually have certain traits in common: First of all, they are not affiliated with a licensed pharmaceutical company, usually because they either have decided Big Pharma is evil (a common problem in our society), because they do not have the credentials required to work for such a company, because any pharmaceutical company will look at their idea and say it's not worth the investment because it's so unlikely to work compared to the cost involved to develop it, or, and this is rare, because the pharmaceutical companies do not want the product to be made as it will not make them any money.

For example, medical marijuana? Pharmaceutical companies are just NOW starting to investigate it as a serious pain reliever, and they will never market it unless it is completely refined and processed because they're hardly going to make money if they announce that we can grow an effective painkiller in our backyards with absolutely no need for them. They are a business. Does that make them evil? No. They're still gonna look into it, and maybe whatever they come up with will be safer and more effective than smoking pot and it will be great. But they're a business. And if they weren't a business, where would the enormous amount of money required to research, develop, and test new medications come from? I don't know about you, but I sure as hell would prefer a business in charge of making sure my pain pills work so well that I keep buying from them and not their competitor than the government to be in charge of churning out the cheapest possible medication to shut me up while they lower taxes.

Anyway, back to the subject at hand. Alternative medicine. If a practitioner has decided that Big Pharma is evil, they have shot themselves in the foot, because there are three places that a practitioner can get the money and resources to turn an alternative therapy into a mainstream makes-lots-of-money one: Pharmaceutical companies, universities with a bunch of bored grad students, and the government. Strike out the biggest one-- pharmaceutical companies-- and you can have your research done by the lowest-bidder government or the universities, who have to apply for grants which most often come from-- you guessed it-- the government, or private industry like a pharmaceutical company. As it is, universities do a lot of testing on alternative medicine, but they can't do it in the same organized, methodical way that a pharmaceutical company with a lot of money riding on it can.

Now let's assume that they didn't go into it hating pharmaceutical companies, and instead applied to them and were turned down due to lack of credentials or the compnay thinking it was a poor investment. If they have insufficient credentials, then they should either go back to school and get the needed credentials and see if they still think that chelation will treat autism, or find someone who does have the credentials who is similarly interested. Chances are if they don't have the credentials and can't get them, or get someone with them to take an interest in their work, their work is based on that dream they had last week and not on actual rational thought, and you shouldn't be using it.

But what if they have the credentials, but the pharmaceutical company simply decided not to invest in whatever they are supporting? Well, that doesn't mean that Big Pharma is out to get them. They're gonna spend the same money on clinical trials and effectiveness studies if they are researching a new cancer wonderdrug as if they are trying to determine if Kombucha tea does anything to the body except look gross. They're gonna look through what evidence there is to support the idea, what evidence there is against it, and then yeah, they're gonna pick the investments that appear to be most likely to be worth the cost. And they pick wrong a lot (that's partially why meds are so pricey), but they're more likely to pick wrong if the wrong is supported by previous scientific study than if it's something the promoter pulled out of his ass. Plus, they have to market it to the mainstream, so even if you assume things like vibrational energy are real and most people are simply deluded, if most people will read vibrational energy on their pain pills and think "Uh, yeah, no thanks, that's ridiculous," a company would be stupid to invest in it.

Then, the final choice, the company doesn't want to do it because it's not gonna make them any money. PHARMACEUTICAL COMPANIES ARE NOT CHARITIES. Come on. They have to get their money back somehow, and clinical trials and R&D are expensive. I don't understand why people assume that doctors, lawyers, pharmaceutical companies etc should exist purely to help them, and not ask for anything in return. Honestly, even if the company WAS a non-profit, as many hospitals are, they can't LOSE money. Money does not magically appear because people are sick or in need, unless you're a politician.

The truth is, there are many alternative therapies out there that probably do work well enough that they would pass all the tests and be a worthwhile investment, but they don't appear it on the surface, or maybe they work but the cost outweighs the benefits compared to just taking the current medication, or maybe they work but not as well as (or as safely as) something we already have, or maybe they work but they sound silly and no one would ever buy them. It's a shame, but it's life. Hopefully those alternative therapies can be tested at universities enough to have a legitimate scientific backing to their claims, and maybe they will then be accepted by the more mainstream industries.

However, those alternative therapies are drowned out by the extremes, the coffee enemas, the chelation for autism, the psychic surgery, the fluoridation conspiracy theories-- the ones that quite clearly have no possible validity to them according to anyone who understands science, anatomy, chemistry, biology and in some cases physics. And that's why the potentially good therapies aren't investigated as they should be or accepted by the mainstream. It's not Big Pharma that's causing them strife, it's the fact that they are being lumped in for whatever reason with every other ridiculous and impossible quack therapy that anyone ever made a million dollars off. So alternative therapy practitioners-- stop blaming Big Pharma. Start blaming the snake oil salesmen.

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However, at the same time, I don't think that alternative therapies should be restricted unless they are actually dangerous. I think they should have to be tested and approved by the FDA according to the same standards as whatever they claim to be. If they claim to be a medicine or remedy, they should be held to the same safety standards as medicine, and require a prescription or not accordingly. If they are dietary supplements, they should also be tested (the US is atrocious in this regard, we need to have stricter guidelines about labeling and contents of supplements-- I'm sick of guessing if a brand of fish oil tablets will work or not). If it's a food, it should have nutritional information.

And if it's toxic, it should be treated as any other toxic substance. Alternative medications, whether they work or not, can be quite dangerous. At least most mainstream medications contain compounds that are safe in low quantities but will cause you to vomit if you overdose-- you're hardly gonna get that with herbal "supplements." Before alternative therapy can be held anywhere near the standards of conventional medicine it needs to hold itself to the same standards of safety.

Oh, and because I read a story about this on the internet: If your child has an ear infection, GIVE THEM THE AMOXICILLIN, don't wait until their eardrum perforates! Good god, it's an antibiotic, not rat poison. At least, if you must try alternative methods, check in their ear first and don't drop your homeopathic ear drops in through the perforation for several days until the kid is puking and screaming nonstop due to the fact you dumped WATER into their MIDDLE EAR. Good lord, that was horrific to read about.

Circumcision and Medical Ethics

Ah, the circumcision debate.

I've been reading a lot about it lately, which probably isn't good for me, but oh well. I've analyzed both sides of the issue, I watched Penn and Teller's Bullshit on it, I read the medical literature. My conclusion is physically, it's not necessary-- but it doesn't harm them, either.

Circumcision has been consistently proven to not decrease fertility (clearly, Eritrea has a 95% rate of circumcision and they have a population growth rate of 2.5% with 33.97 births per 1000 population), it has been proven to have no effect or a positive effect on sex enjoyment and ability to have sex repeatedly, with all studies stating it had no effect on sex drive, two studies saying it improved and two studies saying it decreased erectile function, with three more claiming no difference, most studies claiming it prevented premature ejaculation, of seven studies, only one claimed it decreased penile sensation, and absolutely no studies claiming it decreased overall satisfaction.

In other words, no impact on sex. At all. No impact on fertility. Complications are very rare (comes from practice all these years) and they can be performed under local anesthesia to prevent pain (and should be, after all, we numb ears before piercing). There's some evidence that they reduce the risk of STDs, including AIDS, but there haven't been enough studies for me to comfortably say that is the case, and anyway, condoms do a much better job. The truth is, medically, there's not really any reason to bother circumcising, and it's just a body modification which we perform for aesthetic and cultural reasons. At the same time, though, it's not actually doing any long-term damage. I think the closest real comparison we have is the idea of piercing ears. Pierced ears are incredibly common, they show up in many cultures, and piercing usually happens when the person is still a child or a teen (ie not a legal adult). They are socially acceptable, and yet, they are body modification-- it is punching holes in a child's body and forcing the skin to grow back around a metal object to produce a permanent hole. They also hurt like all hell if you don't get numbed first.

So the question-- medically, neonate circumcisions (usually, barring complications) aren't needed; thus, are they ethical? Well, pierced ears aren't considered unethical. I don't think I'd want to pierce a baby's ears myself, but I wouldn't stop someone who did so to their kid, and it's quite common. And since there is no long-term pain or disability, there's nothing unethical about doing it as an initiation into a religion or something. People do all kinds of weird shit to their kids in the name of religion, and body modification is a common religious practice, so as long as the kid's life isn't really impacted, I see no objection to that. Provided, naturally, that the religious official performing the circumcision is trained, licensed, and willing to use anesthetic.

But what about people who simply think the circumcised penis looks better? Is it ethical for a doctor to circumcise a boy?

Honestly? I don't think so. I don't really like the idea of doctors doing it. However, at the same time, I think we should have people who are licensed and trained to perform circumcisions for anyone who wants it for their son or themselves. The trouble with doctors doing it is it becomes about "healing" the kid somehow. I say take medicine out of the equation, except in the sense that a person performing a circumcision should have training and licensing, same as someone who does tattoos or piercings, and more so because a mistake could be problematic. Or perhaps list it as a form of plastic surgery or something. I think it should be made quite clear to parents that it is an aesthetic/religious, not medical, choice for them to make.

But ethically, I see no problem with them making that choice. It's not like FGM, where a woman can no longer enjoy sex because her sexual organs have been cut out. The foreskin is a small and relatively insignificant part of the genitalia. Losing it does not cause lasting pain, it does not decrease sexual abilities, nothing. In other words, yes, it is a body modification, yes, it is unnecessary, no, doctors should never suggest it or encourage it for medical reasons (unless there actually IS a medical reason, like phimosis), though they should answer any questions as free from personal bias as possible. At the same time, I think that it is still firmly the choice of the parents and there is nothing unethical about allowing parents to choose to do so to their son. If it bothers him that much, he can have it restored as an adult, same as the girl whose ears are pierced can let them grow back together.

And me personally? I don't really care. I don't practice a religion that cares about foreskins, and while I find circumcision more aesthetically pleasing myself, my opinion on the appearance of my son's penis is irrelevant, what matters is what his future girlfriends/spouse thinks of it. What I find more attractive shouldn't really apply to my son's genitals. So I'll probably defer to my husband on the subject.

Too much of medicine is stuck in the 1950s

I have a question/idea.

I'm hoping to go into medicine. So I read a lot of people's opinions of doctors, and their mistakes, etc. You know, figure out what I should keep in mind. One thing I notice is that a lot of people complain that doctors just have a few medications that they prescribe for everything, and that medication interactions are common, especially if you're taking a lot of different meds. It's understandable; there's like a thousand plus medications on the market and doctors aren't perfect.

The thing about this, though, is, I can't help thinking it would be really easy to fix. All the doctors I've seen have a laptop they carry in to their session with me, so they can check my old medical records against my new info, update their records, etc, without having to carry in folders (they print out a hard copy later, I presume, they have files too). Anyway, they have a laptop right in front of them. Couldn't somebody come up with a program for doctors that enables them to enter a medication name and it immediately comes up with what the meds can treat, what they are normally prescribed for, their various approval ratings (government, etc), their prices, any recent recalls or class-action suits, any side-effects, and any interactions with other drugs? And couldn't that same program be modified so that a doctor could enter the diagnosis, say, "chronic joint pain," and would be immediately provided with a list of medications commonly prescribed to treat chronic joint pain? You could maybe even do a cross-referencing program so that doctors could list current medications and the ones with interactions would be eliminated from the list, for people with lots of medication (obviously unnecessary for someone who's taking only a few pills, but if you get an elderly woman with 25 medications she's on...).

Doctors could prescribe generics when people don't have sufficient insurance to cover the name-brand ones, because they would have access to the generic brand names. Of course, insured people would still get name-brands, because they've proven that the placebo effect means name-brands can work better. They could double-check prescriptions very quickly and could learn if a medication someone was on could be causing symptoms. Better care, less problems to fix down the road, insurance companies win. Better care, patients win. Slight reduction in malpractice lawsuits, happier patients, and more memory space to devote to diagnosing techniques, doctors win. Even pharmaceutical companies would benefit because they could get their lesser-known drugs out and prescribed to patients who are always getting their competitor's medication. Okay, that might be a stretch.

But in the end, if the only people who suffer are pharmaceutical companies and only in the fact that they couldn't get doctors who were quite as devoted to them due to knowing of the top of their heads that they didn't have a lot of recalls or anything, I say that's a win. I have no idea why this hasn't been created and put into widespread use yet. It's not like we don't have the ability, there are online sites that basically do the same thing, but doctors are still relying on memory (at least mine are).

If any computer programmer wants to design this and sell it for millions, feel free to steal my idea, no royalties required. I'd be benefiting as much as anyone.

Now, anyone want to tell me why this wouldn't work, or wouldn't be popular, or how my doctors are actually idiots and there already is something like this out there?

Vaccination and Autism

You know what gets me about the whole antivaccine/vaccines cause autism bullshit?

Well, first of all, obviously vaccines don't cause autism, all the evidence has proved this over and over again. Besides, if it was caused by vaccines it couldn't be heritable, and it is (though not entirely). And kids still get autism even now that there's no mercury in the vaccines. Sorry, find a new scapegoat.

But even beyond that-- let's assume the autism really was caused by vaccines. Autism is a) non-contagious, b) non-deadly, and c) present in a spectrum, with most people within that spectrum perfectly capable of living a reasonably successful or normal life, although they're not really socially adept (neither am I, and I survive). Full blown autism is only about one in 1000 people. So in our hypothetical scenario, there is only a 0.001% chance that getting a vaccine will result in an autistic child.

Compare to the alternative, not getting the vaccine. Let's look at the DTP vaccine. Diphtheria has a 5-10% fatality rate in children under 5 years and a 20% fatality rate in adults over 40. Before the vaccine was invented, a person had a 0.002% chance of getting diphtheria. Also, diphtheria is a heck of a lot worse than autism (not that autism isn't horrible, but at least it doesn't involve open sores). And that is a single disease; things like pertussis, measles, and whooping cough add to the chance that an unvaccinated person will get SOME horrible illness. I mean, unvaccinated children living in our modern, vaccinated society manage to get polio, despite the fact that the virus can't easily perpetuate in a population that is immune to it.

So even using the false hypothesis that vaccines cause autism, it's STILL better to vaccinate, because an unvaccinated child has a greater chance of getting an illness that can be prevented by vaccines than a vaccinated child would have of getting autism. Also, most illnesses that vaccines prevent are far, far more painful, dangerous, and deadly than autism is, even at it's absolute worst.

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I'm not a huge fan of over-vaccination, which I define as vaccinating against things that aren't actually going to hurt you too much in the long run, like chickenpox (well, unless you're in your teens or older and never had it as a child), or things that could hurt you, but your lifestyle, age, and/or health make catching a bad case unlikely (like influenza for me, but not for my best friend, who often works with individuals who are high-risk for catching it).

But to prevent polio, diphtheria, rubella... there is no excuse for not vaccinating children against those illnesses. Not even religious objections (will God really stop a person from entering Heaven just because they got a shot? Wouldn't it be a worse sin to not get a shot, and catch and spread the illness, killing yourself and another? And can't you atone and describe yourself as some kind of martyr who was forced into it, anyway?).

Certain vaccines are a public health concern, they should NOT be optional. Even if it meant I had to take a flu shot every year, I'd support legislation that would force all parents to vaccinate their children without exception. If they object, force them to watch a movie about Typhoid Mary. When it comes to serious infectious disease, the government has a duty to restrict the rights of it's citizens enough to protect other citizens, and the more people we vaccinate against a disease, the more likely that disease will go the way of smallpox, no one will ever be at risk again, and we won't need the vaccine any more.

The only reasonable and safe way to stop the widespread vaccination of children is to continue it, even increase it, until it is no longer needed at all. Period.

Is hospital birth traumatic?

I've read a bunch of stuff comparing home birth to hospital birth lately and I've been thinking about it a lot. The thing is, giving birth at home is higher risk. This is undeniable. Fetal mortality or injury happens more frequently. The data is there.

But at the same time... We have babies who are born who are GROTESQUELY deformed, who normally would not live through birth, and for good reason. Obstetrics often interferes with natural processes, and while it is the mother's choice if she wants to go to such extremes for an infant who will die soon anyway, or need massive surgery, or something, in this country the law says we have to save every child we can at birth. Home birth probably can be called more "natural" birth because deformed babies who shouldn't survive are less likely to.

And there is truth in the "traumatic" nature of hospital births-- many, many doctors are pricks who treat all their patients like idiots, and many OBs will severely disrespect the mother by, say, assuming she'll change her mind, or inducing labor when they shouldn't, or manhandling her. Should all efforts be made to save the baby? Yes. But there are a lot of processes that are done in hospitals frequently not because of the health of the mom or the baby, but because of convenience.

Episiotomies are a classic example. Most women don't need episiotomies. They might tear, but tearing will heal, and there are non-invasive methods to prevent tearing. Episiotomies should only be done if the vagina can't naturally stretch for some reason (like the birth is very, very fast), the baby is actually impeded from exiting, there is fetal distress (like his heart rate stops) and they need to resuscitate, or in some cases, if there's a breech birth (as in the picture at right, a footling breech). Many OBs do episiotomies to speed things along when they aren't needed, and what's worse, many of them used to sew up the vulva tighter than was needed, calling it a "Daddy stitch." I don't know how common that is today, though. Unnecessary episiotomies are a danger (of infection, of painful healing) that needn't be taken.

Many people describe "birth trauma" as originating from being touched or entered without direct consent. This one kind of bugs me, because how hard is is before the labor really gets going to say, "I may need to touch you in this way for this reason, in this way for this reason, in this way for THIS reason..." and then do a quick warning before actually touching? There was a story on the Navelgazing Midwife's blog about a woman who had a doctor put her hand up her vagina and into her uterus, without any sort of pain killer, with no more warning than "Brace yourself, sweetie, this is gonna hurt." Would it be so hard to say, "I need to do thus-and-such or you will have complications, and I have to put my hand up there, and would you like a shot? But I have to do it soon."

I mean, yes, there are times when things are happening too fast to really ask for permission every time you touch between the woman's legs, but not always. The least a doctor can do is not offer an epidural more than once until the woman asks for one (it's not just about doing it "naturally"-- I know, for example, that I will want to wait until I feel it is unbearable before I get an epidural simply because I don't like any meds that I don't really, really need), and neither allow the nurses to say disrespectful or manipulative things nor say them themselves.

They should really have a better code for OBs, more specific than the Hippocratic. There's a lot of things they do that they shouldn't or should do a little differently. Actually, gynecologists and ER docs in general need a better code for handling female reproductive systems, especially for rape tests, which if they are not done properly can feel very invasive. I can't remember where I was reading this (Feministing?), but someone was talking about a doctor who brought students in to see the pattern of bruising on her thighs after she was raped, despite never clarifying with her that that was okay, and tried to take pictures for the jury if she decided to go to trial. I was reading that and thinking, uh, why couldn't they cover her genitals with a cloth or something, and just take pictures of her thighs? It would still show the evidence without making her feel violated.

My feeling on home birth is it's okay as long as one accepts the higher risks, and those risks are made clear. I also think that direct-entry midwives (who require only on-the-job training and maybe a few classes) should have much stricter regulations and certification as such. And hospital birth should be done in a more delicate, caring manner. Women at that time are flooded with hormones, they need to have people who understand their emotional needs. And no doctor should ever treat a woman with less respect, consideration and care because she was a home birth transfer to the hospital after a complication.

And one more thing-- unless the baby is going to be put up for adoption or is in the NICU, the mother should get to hold the baby either right after the birth or the second she (the mother) wakes up. I'm of the opinion that it should be quickly wipe down, towel off, check for immediate problems and hand to the mother, or the father if the mother is under anesthesia at the time. That sort of thing rarely causes problems and means the world to parents.

Men's docs probably have similar problems with making men feel violated, like in proctology, but it comes up less often and I want to be an OB/gyn, so naturally I'm focusing on that issue.

To find out more, here's what I've been reading:

Navelgazing Midwife is a natural birth and home birth advocate and works as a midwife/birth coach.
The Homebirth Debate Blog exposes some of the dangers of home birth and the problems that come from home birth advocacy. Caution-- the writer is very anti-home birth. However, she cites real articles and studies so you can read those.