Complementary medicine: Time to ditch your doctor?
In our Pill Nation, between the tender ages of 18 and 29, 40% take prescription medications. By 65, almost all (90%) are on something.
Then we hear these stories:
"M," age 21, has anxiety and insomnia. She started taking an antidepressant. It helped her sleep, but she developed blurred vision and was tired all the time. She stopped the drug (without telling her doctor) and tried meditation.
"Ms. G," 82, has had progressive foot pain and numbness for decades. Many doctors later, she had no diagnosis or prognosis. She gave me the names of several herbs. “In your experience, what works?”
Embarrassingly, I didn’t know. I’ve only heard of turmeric, and that’s from cooking.
Conventional medicine is what I do. I went to medical school. I learned to read scientific articles critically. I follow guidelines and best practices for my patients.
But I’m fully aware of the reach of vigorous science. In primary care, one in five (18%) decisions are based on solid science – exercise, quit smoking, eat broccoli by the bushel. The rest are expert opinions, traditions, gut feelings.
While doctors’ best guesses are not bad, experts estimate up to 1 in 4 medical studies or interventions may be unnecessary.
These exercises in futility can be a simple task or a serious intervention. Examples include: asking a diabetic patient who only takes pills (no insulin) to check glucose daily (instead of every few days), or spine fusion in a patient with chronic back pain.
So I see the attraction and need for complementary medicine – which include acupuncture, dietary supplements, massage, hypnosis, meditation, etc. For example, you take lisinopril for your high blood pressure, but also do acupuncture.
Two potential concerns of complementary medicine: the lack of both scientific evidence and FDA oversight. But many measures have passed scientific muster. Today, spinal manipulation, massage, yoga, tai chi, qigong, and acupuncture are considered “cornerstones” of pain management by the Centers for Disease Control. Meditation helps anxiety as well as some prescription drugs.
But because of the lack of FDA oversight, what’s on the label may not be what’s in the pill. A 2022 study measured the actual amount of melatonin in 26 products. Only 3 (12%) contained melatonin corresponding roughly to what the label claimed. One preparation contained cannabidiol (a marijuana product) and no melatonin; the others’ melatonin content varied wildly (74% to 347%) from the labels. Previous studies support this finding.
It’s a nasty business. In the past 10 years, melatonin overdose in children (mostly accidental) was responsible for 27,795 ER/clinic visits, 4,097 hospitalizations, 287 ICU admissions, and 2 deaths.
To take the best of both worlds, I suggest doing some investigative homework first. A friend’s sage advice: start with websites that end with .gov or .edu.
Here’s what I did. To check Ms. G’s list of Chinese herbs, I started with the NIH National Center for Complementary and Integrative Health website, nccih.nih.gov. It’s comprehensive, evidence-based, easy reading, and free. Its “Herbs at a Glance” lists 54 herbs.
I learned what turmeric is (a type of ginger), what it claims to treat, and what evidence – if any – can back the claims. The end is a list of competing websites and references. Words they don’t use: guarantee, rejuvenate, miracle, promise, secrets, cure all…
Somebody said, “Medicine works, or it doesn’t work.” I said to Ms. G. “Turmeric seems safe. Try it.”