On alternative medicine

The most “open-minded” thing I’ve done this year is to try this so-called natural medicine thing from a consumer point of view. Whenever I tell this story people almost gasp in disbelief: Yes, me, an Australian-trained doctor trying this thing we have been taught since medical school is mostly witchcraft. And yes, I admit, that is (or at least was) my own view on this. The common medical literature tells us “natural medicine” is not scientifically-evaluated, poorly understood because for the most part it’s not in line with the common biopsychosocial model of medicine, and that it’s potentially very dangerous.

Sometimes patients ask me what my views on natural medicine are, and essentially they mean to ask my medical opinion on whether certain natural medicine treatments will help their condition or not. My response is almost always the same: “If you believe it’ll work, it probably will. If you don’t, it won’t”. I don’t know if that’s true, but I’m pretty close to certain that it is true when we are talking about homeopathy. My response is also an acknowledgement to the God-blessed and irrefutable placebo effect. And that is about the extent of my knowledge on non-Western (or alternative) Medicine.

My experience with alternative medicine until a few weeks ago did not leave me with the best of impressions, and they were mostly experiences I had had through my patients. However, before starting to share some of these experiences, I would like to say that I don’t intend to vilify or defame something which I have just admitted to understanding so little, in telling these few stories.

The most recent gimmick I fear for my patients sake are the “full-body scans” that promote themselves as being ‘scientifically-proven’ for the diagnosis of a multitude of vague complaints. They spit out beautiful 3D images and buzz words like “inflammation” or “congestion” and the name of a body organ. Patients pay hundreds of their dollars for the beautiful colour printout they get after having their temperature, blood pressure, pulse, and maybe even respiratory rate measured. But the point is they get what they want because some manufacturer has figured out how to give the patient what he wants (to be taken seriously, to feel cared for, education about his condition, etc.) in exchange for what he wants (money). Oh and how it breaks my heart to have my patient come back to tell me he has stopped taking all his heart medication because the printout said nothing about anything being wrong with his heart only about his spleen being ‘congested’. Or sometimes they’ll come back with a list of obscure tests the naturopath or someone has asked he have checked though you think they are not clinically indicated. So you explain to the patient that those tests may be performed privately, with the cost to the patient, and suddenly they think you are the devil because you are the one who told them about the cost even though it’s not a price you’re setting or something you even think they need… There are many frustrating stories out there from clinicians whose patients have sought the services of an alternative medicine practitioner and some have happy endings and some drastically worse, but what I really wanted to share this week was about my personal experience.

Now, a few weeks ago I allowed my mother to talk me into trialling some “alternative medicine” through a Chinese medicine practitioner one of her friends had recommended. This is the common referral method in this field; word of mouth. So I went along to see this gentleman about a vague diagnosis of “depression” which mum had noted I had increasingly being struggling with (since a recent change in my life circumstances, so probably not even real clinical depression but a temporary low mood). But, hey, I thought I had little to lose so I went. The nice Chinese man with only basic English began by taking a routine medical history and a brief clinical examination (checking some aspect of my pulse and looking at my tongue). He asked about medication I was taking, and after looking at my tongue told me I had a problem with indigestion and ‘loose stools’. He also said I don’t like change and that is why I had “depression”, it was so easy, he said, to see that in me (I call that being human, but whatever).  And he said he could help me if I followed him. Then he took me to another room for acupuncture.

As I lay down on the bed, knowing how “well-educated” people consider me to be, I felt I truly had no idea what was going on and what was going to happen or the mechanism by which it was meant to help my very vague collection of symptoms (including the ‘loose stools’ or ‘indigestion’ which I had not noticed or even bothered me before, and the reactive low mood in response to some changes in my life). I remembered what I told my patients, and I decided to trust the guy about to stick needles in me. I wondered if he could sense my ambivalence and distrust, but truth is it doesn’t take any kind of professional to recognise that in another human being. I wondered just why I was going along with this: To “cure” myself of ailments I probably didn’t even have? To please my mother? To see what all this ”quackery” was about? I think it was a combination of all the above, but despite my reasons, I knew there was nothing imaginary about the needles about to pierce my skin.

He came back in the little cubicle with (to my relief) sterilely-packed acupuncture needles and ethanol wipes. He inserted 11 needles in me, on both sides of my body: 2 near the fibular head, one posterior to the medial malleolus, one on the palmar aspect of my wrist, one just behind each mastoid process, and a final one on the very top of my head into my scalp. What I’ve always being told about acupuncture is that they use tiny tiny needles; what I didn’t realise until the day of my first session was that these tiny needles still hurt! After I had the needles inserted, I was left in the cubicle for 30 minutes and a soft harp music was played over the speakers.

I didn’t know what I was supposed to think about for those 30 minutes, so I started thinking all sorts of things. I couldn’t move because every time I moved, sharp stabbing pains would shoot through the spots where the needles were in me. First I thought I was meant to focus on the music and just relax, however I was in the middle of an Asian-dense shopping centre and people were talking and shouting and that kept distracting me. Then I thought I might focus at the point tenderness the needles were causing me, but that got old pretty quick too. So I started to try to decipher how the whole acupuncture thing works. The guy who put the needles in me hadn’t explained it to me, but actually I remembered that one session in medical school where we briefly discussed about alternative medicine. It was something about Chi channels, which don’t correlate to lymphatic or nervous or vascular channels and have possibly no anatomically corresponding structures to account for them. Then something about the balance of the Ying and Yang, which are some metaphysical constructs related to health and life in general… Oh Gosh, I was half making it up and I was still no closer to understanding what I was at that moment meant to be going through.

Finally the 30 minutes were over and the Chinese medicine practitioner told me to get up and follow him. He asked how I felt. Um, I felt like I had just had being laying down for 30 minutes listening to relaxing music while having needles pierced in my skin. What was I meant to feel? Spiritual enlightment? Physical invigoration? Relaxed? I felt relieved, honestly, because my neck was sore and I needed to change my posture. So that’s what I felt, relief; but I didn’t think that that was what the nice Chinese man wanted to hear so I said I felt “better”. I remembered how I sometimes treat patients for things they don’t fully understand (though I try to explain) like hypertension. I tell them the medication won’t make them “feel” any different, let alone any better, it’s not meant to. They may not feel sick, but untreated high blood pressure increases you risk of things no-one wants to have like heart attacks and strokes. So they take the medicines I give them though they don’t notice any change, except maybe some side-effects, and they trust the 2 minute explanation I have given them as to why it’s good for them. I felt a bit like that with my Chinese medicine practitioner, though he asks me how I feel. I like this guy, he’s a nice man, he is trying to achieve something with me here, so though I don’t know what the right answer is, I don’t want to call either him or myself a failure... Better, I must feel better.

He charges me more than I would charge a patient for a consultation of equal duration and he picks out some pill boxes from his shop, all in Asian writing I can’t understand. He says take 40 of these tablets twice a day. What?! No, no, it’s fine, he says. He tells me he can “guarantee” they aren’t going to cause any side-effects; that they are free of these evil “chemicals” the medicines I prescribe have. Of course, they are “all-natural”. I ask what they are. They are “natural remedies” with “natural” ingredients to treat my loose stools and indigestion. Oh yeah, those things that weren’t even causing me any discomfort. He books me in for a further 4 acupuncture sessions which will make me feel even “better”. My heart sinks because my mother has heard this whole exchange and she’s ecstatic!

I went along to the other 4 sessions, my mother kindly driving me in and even offering to pay my fees. My mood is still a bit low and my self-esteem a bit shattered from the personal difficulties I had faced a few weeks earlier, so I don’t have the courage to say no. I even take the 80+ tablets twice a day for a few days until I get constipated… At my second acupuncture session he asks whether I have stopped taking my other “non-natural” medicines yet. I didn’t know I had to, but no, I haven’t. I understand the potential side-effects from stopping my medication abruptly. A cold chill goes through me thinking that this is exactly what my patients face, and no wonder they do stop their medications and suffer the consequences. It seems so cruel to me. He asks if I feel better. Well, time is helping heal my emotional wounds that had being inflicted some weeks ago, and I’m pretty sure that would have happened despite the “natural remedies” and acupuncture; but yes, nice man, I am better. Is the “indigestion” better? Am I free of the ‘loose stools’ yet? Yes, nice man, I am free of those things I didn’t even know were problems... Eventually, I’ve spent so much money, I have got so much “better” (judging by what I am telling the nice man), and my self-esteem and normal affect have returned that I just can’t continue this whole thing.

And am I better because of the intricate placebo I have just trialled? Or am I better because I never was ill? I don’t know, but I have at the least realised the effect of faith has on healing. When my patients seek alternative medicine methods, they are usually at their most vulnerable and desperate to be well again. I would be better to see them more frequently, to engage them, to ask (maybe demand?) improvement from them. Maybe if I keep asking them if they are better, maybe if I keep seeing them once or twice a week, maybe if I make them believe the challenge is not just his but his and mine, maybe if I keep asking him to take his medication time and time again, maybe if I pay him personal human to human attention, he will get better. And I think that is the lesson in this for me: that is the kind of practitioner we need to become a bit closer to being, rather than leaving all these tasks to the alternative medicine practitioner, who may or may not also give the best medical advice.