Archive for January 16th, 2009
As a young mother comforts her feverish and uncomfortable infant, a handsome doctor enters the dimly lit exam room. The child’s mother and the bedside nurse look at him expectantly.
“I’ve got the results. There is an infection in your son’s spinal fluid, which was one of the things we discussed as a possible cause of his high fever and irritablity,” the physician explains to the now crying mother. “We need to start treatment right away and admit him to the hospital.”
After answering the distraught mother’s questions and discussing his treatment plan with her, the doctor leaves the room and begins to write orders in the patient’s chart. The nurse, eager to begin appropriate therapy looks over his shoulder with a confused look on his face.
“Excuse me doc, but you’ve got to be a little more clear on that order don’t you think?”
Written in barely legible doctor scribble, next to the date and time of the encounter and above his signature and hospital number, is the lone word antibiotics.
“What do you mean? This child is sick and he needs antibiotics stat!”
“Sure doc, but which one, how much and how often? Where did you go to med school again?”
“Clearly you aren’t current on the literature. Antibiotics have been around for decades and have been proven time and time again to treat infections. Millions of people take them every year. Now you are wasting precious time that could be spent caring for this sick child!”
The nurse, unhappy with the response, storms off to find assistance from his supervisor. The doctor, confident that he is providing competent medical are for his patient, expresses dismay at how closed-minded some of his colleagues are.
Naturally, the above situation is absurd, and the nurse is completely correct in questioning the physician on his order for “antibiotics”. What antibiotic, or antibiotics, are appropriate and at what dose? Through what route, oral or parenteral, should the antibiotic be administered? How often should it be given and for what duration? Five days? Two weeks? To condense the large number of antibiotics available in a hospital pharmacy into one all-encompassing term makes no sense.
Antibiotics are drugs, often consisting of completely different chemical structures and with significantly different side effect profiles. There are varying degrees of effectiveness of each individual antibiotic depending on the bacteria/virus/fungus being treated, the location of the infection, the age of the patient, and the presence of comorbid conditions such as renal or liver failure. Calling for “antibiotics” in this fashion would never happen outside of a poorly written (is there any other kind?) medical drama on Lifetime.
As new antibiotics have been developed over the years, they are studied scientifically on an individual basis. Sure there are classes of antibiotics that work via similar mechanisms, such as breaking down a bacterial cell wall, or that might be effective in killing or delaying the growth of the same types of bacteria, but nobody would make a blanket statement, let alone write an order, like the one stated and written by our fictional physician. Unfortunately, this kind of thinking is rampant in the world of so-called complementary and alternative medicine. It is employed by invidual practitioners and by large government agencies as a means of deceptively gaining a foothold for unproven therapies with little or no plausibility. Their targets are the hearts and minds of consumers as well as a growing number of academic medical institutions. In a number of instances, proponents of these therapies, buoyed by the media-fueled pseudopopularity of a variety of bogus therapies, funding from the National Center for Complementary and Alternative Medicine (NCCAM), and clever marketing, have managed to set up shop in our most hallowed halls of learning.
A common saying amongst advocates of science-based medicine, and skeptics taking on the suprisingly successful incursion of unproven therapies into academic medicine, is that there is really no such thing as alternative medicine. I agree with this completely and would add that there is no such thing as complementary or integrative medicine either, regardless of what NCCAM puts on its website. These are marketing terms meant to distract healthcare consumers and providers from the reality that these therapies have either not been subjected to proper scientific study or that they have failed that study and are held aloft only by a foundation of tenacious, anecdote fueled belief.
When proponents of alternative medicine, far too many of which being influential lawmakers, call for financial support in the form of taxpayer money, they tend to use a similar tactic. They hold up a small group of therapies that have been shown to be effective, typcially entities involving stress reduction, positive lifestyle changes like increased exercise and smoking cessation, improved nutrition, or various herbal remedies, as symbols of how wonderful alternative medicine is. This ignores two important realities. Not suprisingly, these proposed symbols of the success of alternative medicine have been co-opted from the science-based medicine which discovered them and established their benefit. More importantly, these alt med proponents are ignoring the fact that the overwhelming majority of what is considered CAM, whether legitimately or not, is absolute quackery. In other words, just because a good massage helps your migraines or decreases your fatigue it doesn’t mean that non-existant molecules of poison ivy will cure your itchy rash. The use by proponents of terminology like alternative medicine is just as preposterous as our handsome young doctor writing an order for antibiotics. Which alternative therapy? Acupuncture? Homeopathy? Quantum Reiki? And for what indication? Each individual treatment must be investigated for efficacy and safety with the tools of science, not the machinations of politicians and idealogues.
In the not too distant past, treatments supported only by sloppy anecdotal evidence or poorly designed studies that were still being offered to consumers and patients as effective had a name. Rational minded folk were unapologetic when describing a bogus cancer cure or an implausible and disproven treatment for depression as quackery. But over the past couple of decades the quack has become the alternative medicine provider and the bogus treatment has morphed into alternative medicine, CAM, or integrative medicine. This was no accident. The change in terminology has served proponents of quackery quite well by successfully leading the public to think that these therapies or just another way of achieving health. Some may be, most will not. Only science can provide the answers. In the meantime, no therapy should be allowed to circumvent science because of semantics.