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DUBAI
Hi EverybodyWalt and I are grateful to be in Dubai Just getting here was quite an adventure starting in Atlanta on the runway with plane problems. We flew both Thursday and Friday and didn't arrive until 630 AM on Saturday. It took almost another day before we received our luggage. Dubai has been on my Bucket List for a long time. It is a country with few cultural or natural wonder attra
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How to Interrogate an Herbal Medicine: Thunder God Vine
Thunder god vine may not be a useful herbal medicine but the compounds isolated from it are fascinating – if not as medicines, then most certainly as laboratory tools. Nature Chemical Biology recently published an article where a research team from Johns Hopkins, the University of Colorado at Boulder, and Drew University in New Jersey, has determined the molecular mechanism of action of triptolide, an unusual triepoxide compound from the plant.
Tripterygium wilfordii Hook F, or thunder god vine, is known as lei gong teng in Chinese traditional medicine and has a history of use as an anti-inflammatory herb. As with many traditional medicines, usage patterns do not necessarily indicate scientific validity. In fact, a Cochrane review published just last month on herbal therapies for rheumatoid arthritis indicated that the efficacy of thunder god vine was mixed. More concerning is that the herb had significant adverse effects in some trials, from hair loss to one case of aplastic anemia.
Nevertheless, the herb’s components have been studied since the 1970s for since they also appears to kill tumor cells in culture with nanomolar potency and have immunosuppresant activity in animal models. The group of the late natural products chemist at the University of Virginia, S. Morris Kupchan, first identified the unusual structures of triptolide and tripdiolide from Tripterygium wilfordii as described in this 1972 paper from the Journal of the American Chemical Society. Cytotoxic activity toward tumor cells in culture was used to guide the chemical fractionation of extracts. The unusual presence of three consecutive epoxides in the structures of both compounds led Kupchan to hypothesize later in Science that they target leukemia cells by covalent binding to cellular targets involved in cellular growth.
As an aside: Epoxides are chemically reactive groups composed of an oxygen atom bonded to two carbons; the constraints of this triangular structure and the electrons on the oxygen favor the opening of this ring and attack of other atoms such as sulfur, often present in regulatory regions of enzymes. The Wikipedia entry gives a pretty nice primer. The reactivity of epoxides also makes these compounds highly useful intermediates in industry, particularly in the manufacture of ethylene glycol antifreeze and industrial paints and adhesives (e.g. epoxy resins).
Conventional wisdom would drive most scientists to take one look at triptolide and say that this stuff is a royal mess – so chemically reactive that it couldn’t possible have a specific cellular target. It’s probably too “dirty” – so promiscuous in its binding that it probably attacks all manner of sulfhydryl-containing enzymes and blows the cells to smithereens.
However, several groups have shown over the last 10 or 15 years that some epoxide-containing natural products have very specific cellular targets. Epoxides are not so wildly reactive that they bind everything in their midst. Instead, the environment in which the epoxide exists seems to provide some binding specificity. For example, the group of Jun O. Liu, then at MIT, showed in 1998 that another epoxide-containing natural product, fumagillin, exerted its antiangiogenic activity by binding to a protein called methionine aminopeptidase 2 (MetAP2). Similarly, Brent Stockwell at Columbia University and the Howard Hughes Medical Institute recently published a tour de force in another Nature Chemical Biology paper showing that a reactive 2-chloromethylketone compound specifically targets protein disulfide isomerase, preventing neuronal cell death from misfolded proteins with potential use in Alzheimer’s or Huntington’s diseases.
Jun Liu was again at the helm in the current thunder god vine study in Nature Chemical Biology. The group started with a simple approach to narrow down the target of triptolide from thunder god vine: they treated the venerable HeLa cervical carcinoma cell line with the drug and examined the incorporation of the building blocks of DNA, RNA, or protein. Triptolide was several orders of magnitude more potent in rapidly inhibiting RNA synthesis.
In an elegant series of experiments, the researchers progressively dissected the modulation of RNA synthesis – first identifying the multiprotein complex of RNA polymerase II (RNAPII) as the target but acting via a mechanism different from known RNAPII inhibitors such as the mushroom toxin, ?-amanitin.
Further experiments revealed that triptolide bound to a transcription factor component of the RNAPII complex called TFIIH. Then, finally, the investigators demonstrated that triptolide specifically attacked a component of TFIIH called XPB. XPB is a type of DNA unwinding enzyme called a helicase and is involved in DNA repair. The group then made semi-synthetic chemical analogs of triptolide to determine how inhibition of the ATP hydrolyzing activity of XPB correlated with potency in killing HeLa cells. While the rank order of potency of the compounds correlated, the drugs were less potent in attacking the enzyme activity of the XPB protein than in killing HeLa cells. So, it’s unclear as to exactly how binding to XPB is leading to cell killing. The investigators do note that triptolide may have other cellular targets that are less abundant than XPB that contribute to its activity.
Of course, we can’t tell right now if triptolide selectively kills tumor cells relative to normal cells. Again, conventional wisdom would argue that a drug that hits such a crucial target as a transcription factor is unlikely to have selective activity. After all, the classic RNAPII inhibitor ?-amanitin is well-known as a lethal toxin responsible for legendary poisonings by the death cap mushroom, Amanita phalloides. However, low concentrations of such a compound might indeed have some selectivity when given together with a DNA-damaging anticancer drug. But that’s a very fine tightrope to walk.
In the end, triptolide may end up “just” being a useful laboratory tool for understanding the basics of gene transcription and DNA repair. But if normally disregarded epoxides do indeed have some specificity in their action on cellular targets, perhaps analogs can be made with selective action against tumor cells. Many triptolide analogs have been synthesized over the years and should certainly be revisited in the context of cancer treatment. But this finding should also serve to warn us that the indiscriminate use of the herb as an anti-inflammatory should be revisited, particularly if the dose of the herb gives variable concentrations of compounds with a very low margin of safety.
Titov, D., Gilman, B., He, Q., Bhat, S., Low, W., Dang, Y., Smeaton, M., Demain, A., Miller, P., Kugel, J., Goodrich, J., & Liu, J. (2011). XPB, a subunit of TFIIH, is a target of the natural product triptolide Nature Chemical Biology, 7 (3), 182-188 DOI: 10.1038/nchembio.522
Dr. Oz and John Edward: Just when I thought Dr. Oz couldn’t go any lower, he proves me wrong
I’ve really come to detest Dr. Mehmet Oz.
You remember Dr. Mehmet Oz, don’t you? How can you escape him? He is, after all, Oprah Winfrey’s protege, and of late he’s really been living up (or down) to the example set by his television mentor, who of late apparently thinks nothing of promoting faith healing quack John of God on her show. Following in the footsteps of his much more famous and well-known mentor, this season on his television show, The Dr. Oz Show, Dr. Oz has in some ways imitated Oprah and in some ways gone her one better (one worse, really) in promoting the Oprah-fication of medicine. And this season has been a particularly bad one for science-based medicine on The Dr. Oz Show. Apparently Dr. Oz felt that he had to surpass what he did last season, which included inviting a man whom I consider to be one of the foremost sellers of quackery on the Internet, Dr. Joseph Mercola. Prior to that, Dr. Oz had done an episode touting the glories of that form of faith healing known as reiki. In between, he made appearances at various panels of woo-friendly physicians trying to coopt President Obama’s health insurance reform initiative to cover more “holistic” care (i.e., “integrative medicine”).
In the next season, in particular over the last couple of months, Dr. Oz showed me just how wrong I had been when I had previously been saying that Dr. Oz seemed to be mostly science-based but with a soft spot for certain kinds of pseudoscience. This season, Dr. Oz has thrown down the gauntlet to science-based medicine (SBM) and, as I like to put it, crossed the Woo-bicon. First, he not only invited Joe Mercola back on his show, but he did it defiantly, defending Mercola against what I consider to be much-deserved charges of being a seller of quackery and lauding him as a “pioneer of holistic treatments.” A couple of weeks later, Dr. Oz pulled the classic “bait and switch” of alternative medicine, featuring a yoga instructor on his show who also advocated all sorts of Ayruvedic quackery. Then, a mere few days later Dr. Oz, apparently not satisfied at his transformation from nominally science-based to being based solely on whatever would bring him higher ratings, completed his journey to the Dark Side of quackery by credulously featuring a faith healer on his show and hosting what has to be the lamest faith healing that I’ve ever seen in my entire life. After that, I didn’t think Dr. Oz could go much lower, although he tried, two examples of which were his anti-vaccine-sympathetic episode on autism in which he featured Dr. Robert Sears and his utterly reversing a previous scientifically correct stance of his and promoting a dubious and potentially dangerous diet.
So where could Dr. Oz go after these episodes? After his credulous featuring of a faith healer on his show, I didn’t think that even Dr. Oz could or would go any lower. Man, was I wrong. Wrong, wrong, wrong, wrong, wrong! I admit it freely and incredulously. As I found out from all of you, Dr. Oz’s guest on his show on Tuesday this week was psychic scammer John Edward, whose show Crossing Over with John Edward ghoulishly featured Edward convincing bereaved guests that he could speak with their departed loved ones. But it was even worse than it sounds just from my description thus far. How low can a physician go to feature someone like Edward, who claims to be able to talk to the dead but in reality is nothing more than a so-so cold reader? He can entitle his segment featuring Edward, Are Psychics the New Therapists (part 2 and part 3). Dr. Oz even helpfully features a segment in which Edward gives his audience advice on how to harness their psychic powers and a chapter from John Edward’s latest book. As I watched, I couldn’t believe my eyes. I guess that means I just haven’t become cynical enough yet, because Dr. Oz’s trajectory has been so obviously leading to something like this for several months now. After all, once you’ve had a faith healer on your show, there really aren’t any boundaries left with regards to your respect for science to justify barring someone like Edward from your show, are there? Certainly, I can’t think of any, but then I am not Dr. Oz. Come to think of it, Dr. Oz obviously couldn’t think of any, either, which is why John Edward was on his show.
Perhaps the most telling part of the episode came right at the beginning of the John Edward segment, telling about Dr. Oz’s audience, that is. Dr. Oz introduces the segment by saying:
We’ve had more requests to join this show than any other we’ve ever done before, more than weight loss, more than cancer, more than heart disease. The topic? Do you believe we can talk to the dead?
Yes, apparently Dr. Oz’s fans were clamoring to be in the audience for this episode above all others, and throughout the show the audience was completely enthusiastic and fawning, just like the show’s host, who asks the question: Is talking to the dead a new kind of therapy? I kid you not. I wish I were kidding. I really do. Then, Dr. Oz even goes one step beyond by answering his own question with a comment to the effect that “psychic medium John Edward believes it can be,” after which he asks another question: “Could it help you someday?” What follows is a taped segment about grief from “devastating loss” and how some people even resort to trying to talk to the dead, for which, we are told, they need a person like John Edward. Edward then describes grief as an “energetic form of cancer” that will, if not treated, “metastasize to other parts of your life.” This is actually not a bad analogy, but the devastating effect of grief doesn’t mean that one has to lie to the patient. Edward apparently disagrees, as he even assures us that speaking to a psychic medium can be very therapeutic if you’re suffering from grief due to the death of a loved one. Even if that were true, would it justify the lying and deceit inherent in claiming to “speak to the dead”?
After that, Dr. Oz comes back on and finishes the introduction by saying:
Now as a heart surgeon I have seen things about life and death that I just cannot explain and that science can’t study.
So, let’s see. Just because the great and powerful Dr. Oz can’t explain it, he assumes that talking to the dead must be real and that science can’t study it. It’s a massive argument from ignorance combined with special pleading, in which it is assumed that the methods of science are inadequate for studying the phenomenon of people like Edward who claim to be psychic mediums. Dr. Oz lives that attitude as well, as he shows not even the slightest whiff of skepticism, nor does he offer anything more than the most perfunctory of challenges to what Edward is doing. Actually, he doesn’t even do that. Other than a brief question near the beginning about whether people who have limited resources should spend money on a medium or use it to find a good counselor, there are no challenges. Throughout the entire segment, Dr. Oz’s tone is more than just respectful. It’s downright fawning and deferential.
Consistent with that, Oz doesn’t even include a “skeptic” in the audience as he has with previous woo-filled episodes. The closest he comes to it is having Katherine Nordal, PhD of the American Psychological Association, who not really introduced on the show but is described on the APA website as “the executive director for professional practice of the American Psychological Association.” Her job is described as overseeing “the promotion of the professional practice of psychology” and ensuring “psychological services’ accessibility and availability through legislative and judicial advocacy, public education and marketplace initiatives.” I’m not sure what purpose Nordal served because she didn’t really question whether Edward could speak to the dead, which makes her a pretty lousy candidate to play the role of token skeptic that is common on these shows. Then, when Dr. Oz asks her whether finding a medium might be a form of therapy, rather than stating unequivocally that it is not, or at least not a good form of therapy because it involves deceiving the patient in a major way and is thus unethical, she says that it can be a form of therapy, just answering the question in the title of the segment with in the affirmative and giving the imprimatur of the APA to psychic mediums. At the very best, Dr. Nordal was naive and credulous, which led her to be taken advantage of by the producers of the show; at the worst, her behavior was profoundly cynical. What she should have said is that, although some people might find imagining conversations with their deceased loved ones to be comforting, mediums are not professionals; most have no medical or psychological training; and there is no evidence that they can speak with the dead. Given these facts, it is far better to use the services of a qualified psychologist trained in grief counseling.
At this point, Edward goes into his routine. If you ever caught his television show back when it was still on the air, nothing Edward does in his segment on Dr. Oz will come as a surprise. It’s nothing more than the old psychic medium trick of cold reading. This time around, he was actually a lot better at it than I remember him. His “hits” were more common and his “misses” fewer than I remember from the handful of episodes of his old show. In fact, there was one part that turned out so conveniently that I have to wonder if Edward’s people had managed to stage it somehow. At one point, Edward insists that someone in the room has experienced the death of a loved one associated in some way with St. Patrick’s Day or occurring in March. Of course, in an group of people the size of Dr. Oz’s studio audience, the odds are quite high that at least one person there has a relative or friend who died in March within reasonable proximity to St. Patrick’s Day. After badgering the audience, finally a young woman says that a friend of a friend had died in a car crash on St. Patrick’s Day. Predictably, Dr. Oz was awestruck. In fact, if you want to know just how lacking in skepticism Dr. Oz is, just check out this TV Guide article released before the show in which Dr. Oz Says Psychic John Edward “Changed My Life”:
I walked out of that studio thinking, “There’s something here. It’s bizarre. I don’t know what exactly is happening. But it’s definitely something.” I’m a heart surgeon. I can explain a lot of weird things. I’ve seen people who should have died who didn’t. Over the years I’ve had some pretty deep conversations with people who died and say they saw “the light” and came back with stories. I’ve heard many things that are not easy to reconcile with the western scientific mind, so you try to think of a reason for what’s going on. Could it be synapses short-circuiting in the brain that make people think they’re having an out-of-body experience? That’s what a doctor does. He tries to find a rational explanation. But I can’t make up an explanation for what John Edward does. And, again, what was most eerie was his level of detail, the concreteness of it all.
Or, one could say that there are times when Dr. Oz’s knowledge isn’t equal with that of skeptics who actually pay attention to these things. Otherwise he wouldn’t be so amazed by Edward’s transparent schtick. But he is, and once again he uses the argument from incredulity. Worse, he uses his position as a physician to create a false argument from authority. Just because he can’t imagine a scientific explanation for what John Edward does, Oz assumes that there isn’t one, and most of his audience accepts his authority as a surgeon as being reason enough to accept his assertion that science can’t explain Edward:
But I can’t make up an explanation for what John Edward does. And, again, what was most eerie was his level of detail, the concreteness of it all.
Which is, of course, what psychic mediums do. It’s what they do and have done for hundreds of years, if not longer. It’s not for nothing that John Rennie characterized Oz as the “great and gullible.” Dr. Oz was gullible when it came to faith healing and quackery, and he surpasses himself in gullibility in his treatment of John Edward and psychic mediums. What they do and how they do it are not mysteries to, for example, James Randi or Joe Nickell, who quite properly described Edward as “hustling the bereaved.” Both describe how Edward uses the technique of cold reading, and Nickell even describes how Edward has been caught in the past using “hot reading,” or using information gleaned from his minions having chatted up the audience before the taping of his show and then presenting that information as having been received from the dead. When he can’t guess right, Edward’s technique is to do this:
What separates John from other cold readers, is that John works with a sizable audience (the Gallery) and when his readings go like the above, as happens far too often, he will just say that he’s picking up the “energies” of two different or distinct families which is suppose to explain away wrong guesses. Enough wrong guesses or if the guest isn’t cooperating, he will just claim the “energy” is pulling back and then move on to someone else he hopes this time will be more volunteering of information.
This is what Edward appeared ready to do with the “St. Patrick’s Day” connection; that is, until the young woman in the audience finally came forward. She later explained her delay in doing so to fear of standing up and being on the show, after which Edward praised her for being honest.
After watching a sad spectacle like this, that of a once respected surgeon debasing himself with faith healers and psychic mediums, I asked myself what could possibly be going on here. My first thought was that reiki must be a powerful gateway woo, leading to the really hard stuff, like faith healing and psychic mediums. After all, Dr. Oz’s wife is a reiki master, and he got his start in the CAM world by (in)famously allowing reiki masters into his operating room to work their magic (and I do mean the word “magic” literally) on his cardiac patients as he was operating. Ten or fifteen years on, that little incursion into woo seems very quaint.
In actuality, what’s going on here, I think, is more likely to be pure hubris. I submit to you that Dr. Oz has become so enamored with himself and his image as “America’s doctor” an the iconoclast who bucks the medical system, sees beyond “Western medicine,” and is just so much more damned smart than other doctors, that it likely never occurred to him that he could be fooled by a psychic scammer like John Edward just as easily as anyone else. Add to that his need to fill the insatiable maw of his daily TV show with new topics and new guests, coupled with the demands of his audience, who are clearly very much into this sort of thing, and it becomes easy for him to justify having a guest like John Edward as both evidence of his intelligence and open-mindedness and giving the people what they want.
Bread and circuses. That’s apparently what they want. I can only wonder what’s next for The Dr. Oz Show after this? I predict alien abductions. Or maybe the “conspiracy” to keep the One True Cure for Cancer from the people. One of those will be the next topic Dr. Oz tackles. Either that, or David Icke will be involved. It’s coming. I know it.
Help – My Doctor is a Crank!
I often receive e-mail from SBM readers (or SGU listeners) who have had the experience of their doctor, nurse, dentist, physical therapist, or other health care provider recommending to them a treatment option that seems dubious, if not outright pseudoscientific. They want advice on what to do. There are common themes to the e-mails – the writer often feels very uncomfortable in the situation. They do not feel comfortable confronting their provider directly, yet they do not want to acquiesce to the advice either. They are also often asking my opinion about the advice – is it really as wacky as it seems. This uncertainty saps them of their resolve, leaving them feeling a bit helpless.
Here is one such e-mail:
Ten days ago, my wife and I welcomed our first child into the world. She was born a couple weeks early, which left her mouth a bit too small and week to breastfeed effectively. To prevent her from losing too much weight, we were referred to a lactation consultant (who works out of the pediatrics department at the hospital where our daughter was born). This consultant (who is also an RN) suggested a regimen of supplementing nursing with pumped breast milk.
This was working great until my wife’s milk production dropped the day before our follow-up appointment. When we asked what to do about this, the nurse recommended that my wife take fenugreek, an herbal supplement. I was a bit skeptical of this advice, so I asked what it was about fenugreek that helped with milk production. The lactation nurse’s answer was vague — she said things like, Herbs can be helpful for lots of health issues, and, a lot of women I see seem to think it helps (oh, the logical fallacies). When we pushed her on this a little more, she handed us a flyer, printed by the hospital about fenugreek. The flyer seemed to support the use of the supplement, but mentioned that there was no scientific research demonstrating that fenugreek increases milk supply. When we asked why it hadn’t been researched, the nurse responded that there wasn’t a lot of money in lactation and that scientists generally aren’t interested in the kind of things she does (basically, that she was doing the good work that cold-hearted scientists refused to do).
She also mentioned that there was a prescription drug that boosts milk supply, but it carries with it the risk of a pretty serious side effect (depression), so she prefers her patients to try the supplement first. I asked how we could be sure the supplement didn’t also carry the risk of negative side effects if it hadn’t been studied, she simply said that it worked out fine for the patients she’s seen.
My wife and I decided to let it go for the time being and decide later whether or not to go the supplement route (it’s hard to argue with a nurse when you’re under-slept, one of you is topless, and the baby is screaming for food). Fortunately, her milk supply picked up a bit on its own, so we didn’t have to resort to using an untested therapy (yet).
First, let’s address the recommendation – fenugreek to increase breast milk production. Substances that increase milk production are called galactogogues. There are a number of drugs that have been shown to increase milk production, although the levels of evidence varies. For many there are only case series. Oxytocin is supported by double-blind placebo controlled trials, and is both safe and effective. Other commonly used drugs, like metoclopramide, are supported by unblinded case series only.
Fenugreek is a common spice and medicinal herb used in India. Among its putative effects is increased lactation, however, there are no clinical trials to support its use. Recommendations are based upon anecdotes only. This 2010 review article reports:
The side effects most commonly reported are a maple-like smell of the urine, breast milk, and perspiration, diarrhea, as well as the worsening of symptoms in individuals with asthma or hypoglycemia. The potential for transfer to milk or side effects in the infant are unknown. As is the case for most herbal products, the dose necessary to obtain a galactogogic effect has not been defined. Only one study on the effect of fenugreek on lactation has been reported. Swafford asked 10 mothers to maintain a diary of the quantity of milk produced with a pump for a period of two weeks. In the first week, baseline milk production was evaluated; in the second week, mothers took fenugreek, 3 cups, three times daily. In the first week average quantities were 207 ml/day, whereas, milk production in the second week averaged 464 ml/day (p = 0.004). Unfortunately, the report excluded any information regarding the characteristics of the mothers enrolled in the study or the postpartum period during which the study was done. Nevertheless, the daily milk quantities reported during treatment do not seem to be particularly high (reference: Swafford S, Berens P. Effect of fenugreek on breast milk production. Abstract 5th International Meeting of the Academy of Breastfeeding Medicine September 11-13, 2000, Tucson, Ariz Academy of Breastfeeding Medicine News and Views 2000;6(3).)
So – there are side effects, even potentially serious side effects like exacerbating asthma and hypoglycemia. The dosing is unknown, and the one small efficacy study that was done was unimpressive.
There is nothing implausible about the claim that an herb can be an effective galactogogue – herbs can be drugs with pharmacological activity. What is disturbing about the nurse’s recommendation is the double standard. She seems to believe that herbs are inherently safer than drugs, which is a false dichotomy based on the naturalistic fallacy, but not logic or evidence. She essentially recommended an untested drug with uncertain dosing, side effect, or efficacy over drugs with better evidence for both safety and efficacy.
It should also be noted that the e-mailer’s mild production spontaneously increased after the consultation. If she had taken fenugreek, that would have been one more anecdotal report apparently supporting its efficacy.
But onto the real question of the e-mail – how to respond in this situation. My advice is to first not be intimidated. Feel free to express your concerns or uncertainty about the recommendations being made. I commend this e-mailer for asking for published evidence, but don’t take an evasive answer as adequate. Ask for published evidence or authoritative reviews. If they do not have any handy, they can certainly prepare this material for the next visit or simply e-mail it to you.
If you feel up to the task, you can research the question yourself and then ask your health care provider to comment on the material you find (but don’t overwhelm them with mounds of material).
Depending on how egregious the pseudoscientific advice was, you should also consider simply leaving that provider for someone with whom you feel more comfortable and confident. I do recommend, whether or not you stay with the provider, to give them feedback. Express your exact concerns about their advice. How they respond will also tell you a great deal about their approach and dedication to evidence-based practice.
In short, I think patients should feel empowered to push back against practitioners who stray from science and reason as a basis for health care recommendations and practice. Those pushing for anti-science in medicine are certainly vocal, and their agenda will advance if others simply do nothing. In fact – if a practitioner recommended an outright anti-scientific treatment (like homeopathy, say) I would go beyond giving them individual feedback. I would write to the head of their clinic, hospital, or department and express your concerns. You are a consumer as well as a patient, and administrators listen to their consumers.
The above situation is becoming distressingly common, and it is not easy to deal with. It is one more type of harm that is caused by the infiltration of anti-science into medicine. I had a similar experience myself. My wife and I were referred to a practitioner to address a problem with one of our children (I am being deliberately vague on details). At the first visit the practitioner made a comment (as an aside, not directly related to the visit) about vaccines and autism. I, of course, politely challenged her on that statement, and she backpeddled – I think just to end the confrontation. My wife thought that I was inappropriate to challenge her – she was concerned about my accepting the role as patient rather than physician.
At the next visit, however – the visit when the practitioner was giving us her actual recommendations, my wife had a change of heart. The practitioner’s recommendations were entirely limited to “natural” interventions like diet and herbs, and she shied away from any medications. Her recommendations were ideology-based, not evidence-based, and in the end the consultation was entirely useless. My concerns at the first visit – that perhaps this practitioner does not have a firm grasp on the concepts of science-based medicine, were entirely vindicated.
This is an important point – if a practitioner recommends something that is blatantly against the science and evidence, how can you have confidence in any of their recommendations? I am not talking about not being up on one bit of latest evidence – no one can know everything. A serious lapse, however, can reveal a systematic bias in a practitioner’s approach to evidence and practice.
Unfortunately, patients cannot take for granted that a licensed professional is necessarily science-based.
