Much of alternative medicine makes dubious assumptions about the world of healing that set it apart from the real world. In essence, this makes it an untenable world view- at least scientifically speaking- and simply a non-starter. On the other hand, that’s not to say these methods have nothing to offer or teach us. Many of these modalities claim to “reach” people because they tend to cater to clients needs. Though, they often go too far, there is a germ of truth to these claims. By attempting to co-opt very real human social needs –empathy for example- they have in some way helped direct attention to important social aspects of human interaction.
The previous post touched on some of the more nuanced qualities of the “human” side of medicine and how important it is to understand and be aware of the complexities of social interactions –networking- and how it can impact health. It plays into the “art and science” of medicine and reminds us that it is a uniquely human endeavor.
Though it is difficult to wrestle with these issues, it is just as important to consider them as it is to debunk the non-science and falsehoods of alternative methods. This brings us to a related theme regarding the effect of networking.
It’s not a stretch to note that the state of medicine today is full of structural and foundational problems (i.e.; health care distribution, client/doctor relations). For example, pharmaceutical companies can make practicing science and evidence based medicine more challenging than it should be. Market pressures, commercial demands, and fierce competition within the industry create a need to vie for each and every costumer -in this case doctor- and can drive their therapeutic choices to some degree.
Here is where ugly “big pharma” conspiratorial accusations begins to bubble up out of the woodwork and out of many peoples mouths. Indeed there may be shades of this occuring. However, this probably gives the industry too much credit as any business works this way at some level –at least in a capitalistic society. On the other hand, an awareness of these forces (of the market) and how they work is crucial for doctors and patients (especially in this age of direct advertising) so that they can better navigate these sometimes muddy waters.
It needs to be made clear that market pressures drive the alternative medicine market in the same way –perhaps more so- as they do the pharmaceutical industry (sometimes they are one and the same!). In addition, the alternative industry (i.e.; supplements, homeopathic products, Chinese herbs) is not nearly as tightly regulated or policed as their “counterpart” is, making arguments against “big pharma” sound a bit hollow.
The science based medicine blog has a very interesting post “A foolish consistency” by Mark Crislip that discusses the undo influence of industry over the practices of medical doctors. As mentioned, topics like these need to be targeted and discussed openly and honestly. This is the best way to identify real problems and find solutions in a complex world.
By the way, veterinary medicine doesn’t seem -for the most part- to suffer near the pressure our counterparts in human medicine do. It seems easier to stand back and assess a particular drug or machine without some type of “market loyalty” ploy (i.e.; fancy gifts, free good or trips to wherever) getting in the way.
In the world of marketing and consumer “wooing” a saving grace, at least to some degree, with pharmaceutical companies is that they are tightly controlled and claims about their products need to be substantiated. Even with the biases often inherent in substantiating a product, it is still possible to evaluate them critically. That said there is still a question of whether pharmaceutical marketing is always a bad thing.
As noted by Crislip: “Does this marketing lead to worse outcomes? Or just more expensive treatment. I don’t have data. I will note that one of the driving forces of antibiotic resistance in bacteria is the overuse of broad spectrum antibiotics and choice of antibiotics is more often driven by marketing rather than science. Association or causality? ” This is definitely food for thought.
Crislip ends the post with the following quote: “In the interests of patients, physicians must reject the false friendship provided by reps. Physicians must rely on information on drugs from unconflicted sources, and seek friends among those who are not paid to be friends” http://medicine.plosjournals.org/perlserv?request=get-document&doi=10.1371/journal.pmed.0040150
At least one commentator, Dr RW gives doctors a bit more credit in their ability to discern the difference between market pressures and good medicine and find a balance between them.
He notes that “Many physicians I’ve discussed this issue with are aware that they are influenced by pharmaceutical company promotions. There is no reason to think there is massive self deception in the ranks of physicians. On the other hand many physicians would dispute any claim that industry promotions impact negatively on patient outcomes. As you acknowledged, there’s not a shred of evidence that they do. It is equally plausible that industry promotions (and their influence on doctors’ prescribing habits) are beneficial to patient outcomes…”
With respect to doctors applying evidence to practicing medicine as opposed to uncritically following “the market” there probably is some problem. However as Dr RW notes “I suspect many physicians do apply it (evidence). I certainly do. How? By being aware of the bias inherent in industry promotions. By applying appropriate analysis to the claims (e.g. looking not only at relative risk but also absolute risk) and by checking any such claims.”
It bears repeating that evaluating and studying issues like these dynamic market pressures which can impact social networks (doctors and patients) allows for a better understanding of real problems and opens the doors for meaningful improvements. These positive attributes; that of being self critical and self correcting, are part of what makes science based medicine –on balance- such an effective and successful practice as it thrives even in the buffeting winds of demanding special interests.