Sunday, December 2, 2012

CAM textbook chapter analysis, part 1

I am quite annoyed at chapter 44 in my Medical Assisting textbook. The chapter is "Complementary and Alternative Medicine" and is largely a bunch of credulous and vague fluff. There is very little in the chapter that is at all critical of CAM, and so the presence of this chapter is quite likely to give people reading it the impression that these are valid modes of treatment. This chapter has given me cause to question if the information in the other chapters is valid.

The book in question is "Medical Assisting: Administrative and Clinical Procedures Including Anatomy and Physiology" (Well, at least that is the title given inside the book. The cover title ends in "with Anatomy and Physiology" instead.) It is the fourth edition and the ISBN is 978-0-07-337454-3. In this post, and future posts as well, I'll be going through some of the claims this chapter makes and seeing whether they jibe with reality.

I will not intentionally misrepresent anything stated in the book. Quotes will be in quotation marks and in dark red text to distinguish them from my words.

The chapter starts by saying that "The use of complementary and alternative medicine (CAM) is on the rise.", and asserts that "More than one-third of the population older than the age of 18 uses some form of CAM to help them relieve problems and promote wellness." Absolutely no sources are given to support these statistics. These are also arguments from popularity.

The next paragraph tells us that CAM is treatments "that are not necessarily considered to be part of conventional medicine. Conventional medicine, also known as allopathy, is the common and usual practice of physicians and other allied health professionals...." (Emphasis in original text. Bolded words and phrases indicate "key terms".) Right away you can see that the authors have eschewed the more correct definition of alternative medicine, which is "all treatments that have not been proven effective using scientific methods". (Source: National Science Foundation) Additionally, they give undeserved legitimacy to the pejorative word "allopathy". To paraphrase Mike Hall (edit: actually I guess Tim Minchin said it first), if it's proven to work, it's medicine, and if it's not, it's not. You shouldn't get to use weasel words to imply that evidence based medicine is on the same level as made-up, unevidenced systems.

The chapter goes on to distinguish between complementary medicine ("used with conventional medicine") and alternative medicine ("used in place of conventional medicine"). I'm not sure whether this is actually a useful distinction, and the chapter largely lumps them together anyway.

"As therapies are proven to be safe and effective and are adopted into conventional health care, another type of medicine, called integrative medicine, has evolved." Hmm, I'm pretty sure that if something is proven safe and effective, it is just called medicine and you don't need to make up a new term for it just because it used to be unproven. Surely at some point in the past, chemotherapy was a new and unproven treatment, but what oncologist who offers chemotherapy would say that they practice "integrative medicine"? (Excepting, of course, those who also offer non-evidence-based modalities; for example Cancer Treatment Centers of America, who offer chiropractic, naturopathic, Reiki, and other nonscientific treatments along with scientific ones.)

Then there is a bullet point list of the similarities that all types of CAM share:
  • A focus on individualized treatments, good nutrition, and preventive health practices
  • Treatment of the whole person
  • Promotion of self-care and self-healing
  • Recognition of the spiritual nature of the individual
Ah, this shit. As if evidence-based medicine doesn't do any of these things. Ever been to a doctor and told them that the pills you were prescribed were making you sleepy, raising your blood pressure, altering your libido, or just plain not helping the problem they are supposed to? The doctor probably altered the dosage or switched you to a different medication. That's "individualized treatment". Has a doctor ever recommended that you try to eat healthier, get vaccinated, stop smoking, exercise, etc? That's "good nutrition, and preventive health practices".

The second point is something only claimed by alt med people to make real medicine sound bad. Why would treating the whole person be necessarily good? If you have a mental disorder, surely you only need to treat the brain? If you have a toenail fungus, surely you only need to treat the toenail? It's inefficient and usually unnecessary to treat the whole person. Some treatments do, and they usually have what are called "systemic side effects", meaning side effects that affect the body as a whole. You know how some chemo patients lose their hair, feel nauseous and fatigued, have weakened immune systems, etc? Those are systemic side effects. Treatments that are effective without systemic side effects are more valuable, of course, and there are now types of targeted chemotherapy.

When doctors advise you to get plenty of rest and exercise, that's self-care. Self-healing is what your immune system naturally does.

And that last point about recognizing spiritual shit... Spiritual is defined as

1. pertaining to the spirit or the soul
2. Of or pertaining to the God or a Church; sacred
3. Of or pertaining to spirits; supernatural
Of those things, only churches are something that can be proven to exist. I don't believe we should recognize anything that isn't proven to exist. And if the patient has needs pertaining to the church, then these needs are probably much better served by people in their church, rather than their healthcare provider.
However, there are probably many, many doctors who are spiritual and are sensitive to any "spiritual needs" of their patients. There is no reason that this can only be done by quackery peddlers.

The "introduction" part of the chapter concludes by stating that "CAM is constantly changing", "Research is ongoing", "what is considered to be CAM changes continually", etc., and then mentions that "The National Center for Complementary and Alternative Medicine (NCCAM) would be a good place to start looking for the latest research". Leaving aside the fast that NCCAM is clearly a biased source for info on CAM, there is no mention of any of the well-founded criticism of NCCAM, which is handily summarized in Kimball C. Atwood's 2003 article, The Ongoing Problem with the National Center for Complementary and Alternative Medicine. If I assume good faith on the part of the book's authors, perhaps I can imagine that they didn't want to derail the chapter by writing lengthy criticisms of government entities. But it seems that the intellectually honest thing to do would have been to research it, and if it appeared untrustworthy, then either not even mention it, or mention that it is untrustworthy. Sadly, it seems that the authors have done very little research or critical thinking when writing this chapter, but simply regurgitated the claims made by proponents of CAM without question.

This blog post has gone on for longer than I had anticipated, so I will continue my analysis of this chapter another day. If you have any polite comments, feel free to post them. Impolite comments will not be as welcome.

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