Too Many Pills is the most recent Monthly article from doctor & writer, Karen Hitchcock. In it Hitchcock preaches the gospel of evidence-based medicine, demonises ‘alternative medicine’, and highlights the importance of psychological and lifestyle interventions.
Although I agree with all of this in principle, I’m always a little concerned when people bow at the altar of science and modern medicine without acknowledging its history or limitations. In her article Hitchcock says “there is no alternative medicine. There is only medicine that works and medicine that does not work. If an intervention is proven by empirical science to work, it is no longer considered “alternative”. It becomes medicine”. And while in theory she’s right, in reality it’s not that simple.
As a health researcher I’m all too familiar with the length of time it takes to make new discoveries and the effect that publication biases can have on which discoveries are reported. I also know that the translation of research into practice takes time (sometimes as long as 20 years) and relies heavily on the knowledge, skills, and attitudes of individual doctors. Much of what we know now, we didn’t know 50, 100, or 200 years ago. And what some doctors know now, others still haven’t learnt. So I can’t help but wonder, how much of what we think is quackery now, will come to be wide-spread, evidence-based practice in years to come?
To be clear, I’m not advocating homeopathy or reiki, and I’m firmly in favour of vaccinations. But what I am suggesting is a little historical perspective, a better understanding of the nature of research and practice, and a more sympathetic approach to patients whose symptoms, and doctors whose practises, are outside the scope of current knowledge.
To make my point, I want to use a few examples from my own family. The first involves my middle sister and my great-aunt. Born in the 1980s and diagnosed with epilepsy in her late teens, my sister takes prescription medications to keep the seizures at bay. She is also married and holds down a high-powered job in an international city. My great-aunt had epilepsy too. Born eighty years before my sister and coming of age before the widespread use of anti-seizure medications, she spent her adult life in an institution, deemed incapable of having a home or a family of her own. These two women had identical medical conditions – it’s the painfully slow progress of science and evidence-based medicine that separates the quality of their lives. Had either of them been unfortunate enough to have lived in an even earlier time, they would have been exorcised or burned at the stake, their seizures attributed to evil spirits or witchcraft rather than a neurological disorder.
The second example is my grandmother. As a young woman who loved bushwalking and had an active social life, she was often side-lined by mysterious symptoms – digestive problems, cramps, weight loss, and fatigue. Unable to find their cause, a doctor told my grandmother she simply needed to have a baby, that some women’s bodies just weren’t ‘right’ until they’d given birth. This was the 1930s. It was also wrong. What she needed was to stop eating gluten. My grandmother had Celiac’s disease, but the slow progress of science and evidence-based medicine meant she wasn’t diagnosed until she was in her 70s. And by then it was too late – a lifetime of eating the wrong foods had ravaged her body and left her with numerous secondary conditions, including bowel cancer and arthritis.
The third example is my own. A year ago I was diagnosed with Hashimoto’s disease, an autoimmune condition that is slowly destroying my thyroid. At the time of diagnosis I couldn’t walk the ten metres from my front door to my letterbox without needing to sit down. The diagnosing doctor said “If you were having a baby, I’d prescribe you medication. But you’re not. So I won’t”. I thought instantly of my grandmother and then I found another doctor. This one kept himself abreast of the latest research and immediately suggested a combination of prescription medications and over-the-counter iron and Vitamin D supplements. My doctor is also one of the “integrative medicine” GPs that Karen Hitchcock maligns in her article. And while I don’t doubt that some of them are charlatans, mine is informed and cautious and I use my research skills to verify his recommendations. As a result of his treatment plan, I now walk the ten metres to the letterbox, keeping walking to the train station, and then swim 3km in a public pool. All without needing to sit down.
What I hope these examples highlight is that evidence-based medicine is a dynamic, ever evolving thing. It is not static and it relies on human beings to conduct the right research and disseminate, acquire, and correctly apply the evidence. So to suggest that everything we know or do now is right, and everything else is wrong (as Hitchcock has done), is both ignorant and arrogant, not to mention dangerous.
I agree with Karen Hitchcock that many of today’s mystery maladies could be prevented with diet, exercise, and social support; that addressing social inequities and intergenerational disadvantage would be a more valuable response to conditions like ADHD and Type 2 Diabetes than the development of a new drug; that pharmaceutical companies are ‘creating’ new conditions so they can sell drugs to treat them; and that much ‘alternative medicine’ is a waste of time and money. But I think we also need to remember the past, to reflect on the mystery maladies of yesteryear that we now understand to be legitimate (and treatable) medical conditions, and to give some patients with unexplainable symptoms (and some practitioners with novel treatments) the benefit of the doubt. Perhaps, like my grandmother, my great-aunt, and my doctor, they are just ahead of their time.