Thursday, 19 January 2012

Herbals & Gerbils - Fibromyalgia, Doctors & Herbal Remedies

I once had a doctor quite verbal
About how he HATED all herbals.
I told him “I see...
But this stuff is for me.
I don’t CARE it’s not tested on gerbils.”

Face it... doctors can be REALLY pig-headed.  Hey! I can say that, because I am one... and I’m really pig-headed about that.

But aren’t they though? You walk into their office and sit down and wait for a day and a half in your underwear to ask them what they think about this new preparation of green mould tea you’ve been drinking for 6 weeks, pleased as punch that it seems to be working... you’re feeling better, and stronger and more good looking... and even taller... and then once you tell him (or her) about your new-found remedy, he (or she) goes absolutely ballistic on you.

“You’re drinking WHAT????”

And you feel like you’ve just admitted to micro-waving your children.

And then the good doctor goes on to talk about doubled-blinded, randomized placebo-controlled trials, and statistical-significance, and type 1 and type 2 error, and placebo effects, and radishes, and sex in cartoons on TV... and you realize that Doc is REALLY losing it.

Here’s the scoop.  Most alternative therapies are unproven, at least relative to the standards that are required for most drugs... but that does NOT mean they don’t work.

Let’s start by talking about what a randomized placebo-controlled trial (sometimes called a randomized clinical trial) is. It’s typically just a study in which people with a particular health condition are randomly selected either to get some real drug (maybe a pill or a liquid, or maybe an injection), or to get a fake pill or liquid or injection that looks and tastes and smells and plays guitar EXACTLY the same... so no one but some little guy wearing black-rimmed glasses and a toupee working in secret in a small pharmacy in Chicago knows who’s getting what. And no one knows until the study is over, so then researchers can look and see who got better and who didn’t without people’s knowledge of what they were or weren’t taking screwing everything up.

Okay. Perfect. We now KNOW if something works or not. But first of all... do we? Because drugs are invariably tested several times, and invariably they DON’T work in Pittsburgh when they DID work in Los Angeles and Toronto and Paris and your Cousin Harvey’s basement. So which study do you believe? Maybe the guys in Pittsburgh are the only ones who know what the heck they’re doing!  Or maybe the drug works GREAT for the full duration of the 12-week study, and then everyone drops DEAD in week 13.

“Sorry... the study ended last week.”

My point is that even randomized placebo-controlled trials (sometimes called RCTs) aren’t perfect.

Now back to herbals and other controversial alternative therapies like physiotherapy and occupational therapy and counselling. Can we truly give placebo physiotherapy?  “Hey! I may or may not give you physio, and you won’t know it and I won’t know it until the end of 12 weeks!”  Would that WORK? 

How about surgery?  “I may or may not remove your brain tumour, and I'll be operating with my eyes closed.” “Sure Doc, sign me up.”

The fact is that many very well-accepted treatments will NEVER pass the scrutiny of the randomized placebo-controlled clinical trial (sometimes called Frieda). Does that mean THEY don’t work?

“Let’s close the surgery department down because we’ve got no placebo.”

Of COURSE not! And the same is true of herbals and magnets and massage and chiropractic and therapeutic touch and bananas and other treatments that may make your doctor rage and rant. Most of these treatments will never meet the same level of scientific proof as that little pink pill... but that doesn’t mean they don’t work. Many, many drugs we use today once WERE herbal remedies... that have now been ‘PERFECTED’ by purifying them, perhaps modifying them, and then wrapping them in a tasty candy coating, strange name and big price. 

Besides, many of these alternative therapies HAVE been tested, to as high a degree as modern scientific methods will allow... and HAVE been found to be better than mock treatments. Herbals... sure; some of them have been tested and have been shown to be more effective than placebo. We can’t be entirely sure people on ‘placebo’ didn’t get the same ingredients as the magic herb in their diet or somewhere else... but hey! That’s inevitable to some degree. Magnets... YES. Several studies have demonstrated the benefits of magnetic fields on pain. Will little magnets tucked into your Speedo work? I don’t know. But at least the principle of using magnetic fields to treat pain has been tested.  And therapeutic touch... which isn’t touching at all and sounds like complete hooey... actually was proven to speed up wound healing. Go figure!

And what about this damned placebo effect anyway? Some doctors say: “it’s all just a placebo effect.” But if you feel better, WHO THE HECK CARES?  So long as I can afford it and it isn’t hurting me, I don’t care if it’s just mind over matter. If I feel better in my mind... that STILL matters!

I’ve always told people... just be a smart consumer. More specifically:

#1: If something seems too good to be true... it probably is!
If some remedy touts being able to make your pain and fatigue go away forever, and cure you of cancer, diabetes, heart disease, rabies and foot fungus... AND make you 3 inches taller, ten times sexier, and 47.2361% smarter... that’s PROBABLY too good to be true.  

#2. Don't sell the farm 
In general, don’t buy any treatment you have to remortgage your house for, unless the therapist is really, REALLY hot! Seriously, though, if you want to try something out, okay. But buy a small amount to see how it works first. Don't buy a year's supply for 30% before you've had a trial of it. What happens, for example, if you're allergic.  In fact, with creams, I always recommend you apply only a small amount over a very small area of your skin (that you can see, like your arm) to make sure you're not allergic before liberally gooping it on.

#3. Talk to others who’ve tried it whom you trust. 
Find out what their experiences have been. And now that we have Twitter and FaceBook and Linked In and whatever else, you have even more sources to go to. But exercise caution believing people you've never met other than on-line. There's something about you knowing how to get to someone's house that will make them that much more honest.

 #4. And ask your pharmacist.
Despite our big heads, doctors don't actually know as much about drugs and herbals remedies as pharmacists. We understand the diseases to be treated MUCH better (we hope). But pharmacists have YEARS of training in drugs, whereas how drugs work and what side effects they have are only a part of what doctors learn. Ditto of therapists and therapy, nutritionists and diet, etc.  

And otherwise, just use common sense.  And maybe, just maybe, once your doctor sees how well you're doing and stops chattering on about caramel popcorn, how educational the Gong Show used to be, and the horrific plight of monkeys on Mars, he (or she) will come around too.

Kevin White, MD, PhD


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    Remedies for Fibromyalgia

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