Wednesday, June 26, 2013

Religious Differences

Many years ago, medicine was a priesthood. There was little that the physician could offer the patient beyond compassion and prayer. Now western medicine it is increasingly scientific and technological. This has made some diseases more treatable. Many patients survive who might not have without the knowledge and innovations we now have. But, not everyone opts for the same treatment. Why? Because everyone has their own belief system.

Several months ago, I had a patient with a malignant brain tumor that I operated on. She regularly did juice cleanses. Yet, despite the fact that this had not prevented her tumor, she thought it would be able to treat it. Her tumor has continued to progress at a rate consistent with that of  patients receiving no treatment. I've had many other patients who have tried a variety of other "alternative" treatments for their cancers. So far, I have seen little benefit. But, I have seen several patients bankrupted by some of the "alternative" practitioners who demanded payment in advance. Yet these same practitioners accuse conventional providers of scamming the patient to make money. I have never seen conventional practitioners demand payment in full in advance except for purely elective services. I do not deny that medicine has become a business, but most of the physicians I know are not seeing their patients simply in terms of how much they pay. And most hospitals seem willing to work out payment plans if needed.

Recently I read Paul Offit's book on "alternative" medicine. It makes a lot of good points, the most significant being that there is medicine that works and medicine that doesn't. Once something is established as having benefit it is added to the armamentarium of those who practice scientifically based medicine. Many standard medications evolved from herbal remedies once data on their effectiveness became available.
Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine
by Paul A Offit MD

But even within conventional medicine, there are differences in opinion. This is most common where there is a lack of data. But, we all have our biases. I am a neurosurgeon who has additional training in neuro-oncology. I have been involved in treating and following patients who have been treated with chemotherapy, immunotherapy and radiation in addition to surgery. While each of these treatments has risks, they also have benefits. Only when we treat enough patients does the optimal treatment become clear. And even so, that is statistically the best. Individuals may still have side effects and complications. 

A close friend who had accompanied me to several appointments. He, too, has faced cancer. But he is a medical toxicologist. He has seen patients who have had complications of chemotherapy. So, he is more reluctant to consider it unless there is data showing a real advantage. But, where there is such data, he is cautiously in agreement. I have experienced a similar bias in another area. Female hormones such as those in birth control pills may lead to strokes. Sometimes these require neurosurgical intervention. So, I know that I have had a bias against hormonal birth control methods. Yet, millions of women take these without ill effect. 

So, each of us comes to our decisions based on our experience. That gives us a set of biases in terms of deciding on treatment for our patients or ourselves. Sometimes these biases seem absolute, almost like a religious belief. For myself, I would like to have what has been shown to work the best in the most patients with similar disease. And that is what I recommend for my patients. In the absence of such data, one has to extrapolate from what is known to make the best choice. And still, I would ask experts for their opinions. 

1 comment:

  1. Last night, I had a call from a relative who believes in alternative care to the point that she rejects therapy simply because it is suggested by an allopathic physician. She has nearly been bankrpted to pay for the alternative care which she feels is successful, despite progressively worsening to the point that she can no longer dress herself or transfer from bed to chair without assistance. She even needs her aide to dial the phone for her.
    The purpose of the call was to dissuade me from having therapy which has been shown to be beneficial since it might have side effects. I pointed out her progressive decline as evidence that the treatment she has opted to take has not been very effective for her. And that I prefered to try something that has been effective for the majority of patients. She would not relent in her attempt to convert me, though the exchange only reinforced my decision.
    It also demonstrated to me how some alternative care patients display a religious zeal that cannot be addressed by data. Something that I'm sure those who treat them on a cash-up-front basis are only too happy to encourage.