Thursday, September 28, 2006

Sister Fortune

Every day on the way to work I pass an interesting little business. The front window has a couple neon lights that spell out 'Tarot Cards' and 'ESP'. The sign by the highway reads "Sister Liz: Psychic Readings and Advisor". The interesting thing about this is that there are always one or two cars parked out front. Whenever I see this I wonder how many of Sister Liz's clients are also seeing a psychiatrist---or not seeing the psychiatrist they need---and what other alternative treatments they are using. For the most part I don't think a consultation with Sister Liz would do any particular harm other than thinning one's pocketbook. Who am I to complain about a gypsy fortune teller? There are scads of healing paradigms to choose from: chiropractic, aromatherapy, accupuncture, Chinese herbalism, "root" workers, sweat lodge, exorcism, ayurvedic medicine, meridian therapy and even angel adjustment. People talk about rising health care costs, but alternative treatments can be fairly pricey too. Regardless, I think that if they're paying out-of-pocket it's up to them what kind of consultant they see.

My main bone of contention is the use of the term 'complementary' medicine. According to (my favorite source of all things lexicographal) the term 'complementary' means supplying mutual needs or something that completes the whole. The implication is that complements, when combined, offset one another or blend to create a unified whole. Nice idea, but hooey when it comes to medicine. Aromatherapy has as much relevance to traditional medicine as tanks have to gardening. The National Institute of Health has a branch dedicated to studying alternative and complementary therapies of many kinds but it seems to me that the number of proposed therapeutic modalities are growing faster than they can possibly be validated. And as far as I've seen they're not funding any clinical studies on the effects of fortune tellers or exorcists.

Separate from efficacy issues---or lack thereof---there's the question of potential harm. In one study done in Boston, a random sampling of ayurvedic medicines sold in the Boston area revealed that 20% of these compounds were contaminated with heavy metals such as arsenic and lead. There are over a thousand publications in PubMed related to herbal remedies alone; many of these are case reports of serious complications from these interventions.

I'm sure there are many reasons why people don't pursue traditional medicine---lack of finances, fear and trust issues or cultural affiliation---but this does not lessen our obligation to ensure safety and efficacy. And that can't be done by looking in a crystal ball.


Dinah said...

So, I'd be willing to go to a fortune teller with you if you stop bugging me about this wall climbing thing (Roy: are you with the program here? Maybe you could take her climbing?).

ClinkShrink said...

In my crystal ball I see:

a tall dark rock...I mean stranger.

I had a friend who would take his German Shepherd puppy with him climbing. Maybe Max would go with me?

MT said...

I bet angels are low in heavy metals. Also I doubt there exist well-controlled clinical trials demonstrate regular psychotherapy to be more effective at treating anything versus horoscope reading or psychic consultations. Maybe studies show it more effective than sugar pills or drama therapy, but I do not see the definitive study being done until 2012, at which time Deepak Chopra will be president.

DrivingMissMolly said...

You forgot to mention one other reason--desperation.

There is a similar looking little business tucked away on a block in a particularly colorful part of town that offers some of the "services" you describe, as well as others.

I have thought of going there. I see a traditional psychiatrist and therapist. Why would I go?


I have tried at least 20 antidepressants/mood stabilizers, etc. and many combinations of drugs.

I have wanted to go and have a "limpia" (literally Spanish for "cleansing" done to remove any curses that may be on my head.

Do I necessarily believe I am cursed? Maybe. My hope rests in believing that whatever they do will do *something* even if it is just some kind of placebo effect.

...but there is deep down the superstition, the belief, what if I AM cursed? What if my depression/anxiety/personality disorder is caused by nothing more than bad spirits hovering around me....

I have told myself *if* i ever go there are 3 rules. 1) Don't go alone, 2)Don't do anything invasive (a former co-worker had to have surgery to correct the results of an adventure with ear candling), and 3) Do not spend more that $50.

I still haven't gone to the shop...I am afriad to, for the reasons you describe, but as long as my life is reduced to just "existing," even in the face of spending thousands of dollars on traditional medicine, what would I have to lose?

Julie, RN said...

Yes, perhaps the supposed effectiveness of these treatments is the belief that they work, the placebo effect, you know, a delusion. Praying doesn't work, maybe a high colonic will.
Funny you should put this up now, as I have been planning to give my gyne a crystal ball.

Turbo said...

One of the worst situations I saw in med school was a young, perfectly healthy fellow who had taken a notion to have an intravenous "chelation" therapy done by some charlatan in Boston, just in case he might have something that needed chelating-- and in the process got himself directly septicized with a whole bottle full of really nasty bacteria. He was in the hospital for weeks, nearly died...

ClinkShrink said...

JW, that's interesting about the subtle influence of researcher bias. It reminds me of a story I read in one of Stephen J. Gould's books about a man who had a horse he claimed could count. Sure enough, the animal would paw out exactly the right number he was told. It turned out the animal was picking up on subtle behavioral cues that the owner displayed when the number was reached---and he had no idea he was doing it.

Yes Molly you're right---I neglected to mention desparation, thanks. Your mention of the placebo effect brings to mind a story about my friend who takes Vitamin C for colds. I kidded him about it bit, saying there was no evidence it did any good. He shook his finger in my face good-naturedly and said: "It works for me! Don't mess with my placebo effect." Good point. It was a great learning experience about healing given to me by a hair stylist.

What people don't usually know is that there is also a nocebo effect, when an inactive substance causes harm through suggestion. When I see people with loads of side effects to low doses of multiple medications I think it's safe to say there's an element of nocebo happening.

Eesh, Turbo your case sounds awful. There was a guy in Virginia a few years ago who went on trial for offering intravenous aloe vera as a cancer cure. Kind of puts the Xyrem discussion into perspective.

ClinkShrink said...

Clever Hans, that's right---thanks for filling in my brain gap. I get Clever Hans and Little Hans mixed up. The Clever Hans story seemed analogous to the more recent but passing fad of facilitated communcation for kids with autism. Once it was studied they found that the communication was being done by the facilitator. These kind of cases always make me aware that there is unconscious communication going on all the time between doctor/therapist and patient.

I vaguely recall an outcome study of psychotherapy by psych residents that found better outcomes were correlated more with the psychotherapy supervisor than the resident, which I thought was interesting. Supervisor bias wouldn't be unconscious though, since it's taken for granted that the resident is supposed to be following the lead or taking the advice of the supervisor.

Steve & Barb said...

My very first private practice office on Main Street was in the first floor of a home-turned-into-office space. Across the street was a 4-story medical office building. Next door was a non-descript little building where this elderly woman and her little dog lived.

I even had the landlord add to the lease a clause indicating that he would only rent to "professional, respectable businesses" (or words to that effect), as I didn't want to be downstairs from a future tattoo parlor (my apologies to all the professional, respectable tattoo parlors out there).

So, a year after I'd been there, the old lady and her dog put up this huge sign (like, 4x6 feet), propped up against her front porch, impossible to miss while driving by ...


There was big, red palm, and a crystal ball.

Some of my patients joked that if they didn't get better, they could always try next door (I joked back that she was much more costly).

I moved 6 months later. (I guess she knew that was gonna happen.)

Agnes said...

No one can ensure safety. Life is a crap shoot. There are no guarantees. Buyer beware.

Sara said...

We had a patient come in with gangrene in her leg, after having let some "alternative" person do sclerotherapy for varicose veins. Who knows what they injected? My feeling: she had it coming.