Dear Editors…

Interesting article. Wish I could tell you that it is largely
“evidence-based” and far removed from “folk medicine.”

Your publication deserves to maintain the precious credibility it is
earning. Your promotion of articles such as this diminishes your
credibility.

David
Retired pediatrician, Rochester, New York

I received the above response to an article I wrote in Meridian Magazine advocating the use of vitamins to help people be healthy. At the same time, the Wall Street Journal of that day (February 11, 2010) was in front of me. I read an article entitled A Simple Health-Care Fix Fizzles Out, about the research (is that ‘evidence-based’ medicine?) coming out of the Courage study, published in the New England Journal of Medicine in 2007. It found that a $15,000 stent placement in a patient with chronic chest pain did not do better in long term outcome for the patient compared with medication use. This study tracked 2,287 patients for five years, and found no change in mortality or subsequent heart attacks in either group. They reserved stents for those who did not improve with medication therapy.

The article points out that since the 1970s, the ‘evidence-based medicine’ movement has encouraged doctors to use studies like this to decide how to treat patients. Has this happened?

Immediately after the study was printed, there was a 13% drop in stent placements, but it rose to the previous level within a few months. Here are some insightful comments that I have extracted from the article:
• “If a doctor attempted to persuade a patient to delay stenting in order to see whether drug treatment would work by itself, the patient would likely drop him and see another cardiologist instead.”
• “Patients have little incentive to decline costly care when insurers are paying. Interventional cardiologists, on the other hand, have a financial incentive to use stents-they receive about $900 per stenting procedure, roughly nine times the amount they get for an office visit.”
• When researchers asked for assistance trying to decide who should be eligible for these guidelines, “The industry and doctors declined to help. ‘We don’t want to end up being our own willing executioners.’”

Curiously, the very next day, the Wall Street Journal reported the former President Bill Clinton underwent “emergency heart treatment,” after suffering chest discomfort and had “stents placed in a coronary artery.” Apparently his doctors did not read the Courage study, or perhaps they disregarded it as “folk medicine.”

Vitamins: “FOLK Medicine?”

The research support for the use of vitamins is voluminous. Just because it is not in physician-read mainstream medicine journals (and there is some there), it does not mean it does not exist.

Just because you or I have not read it, it does not mean it does not exist. There are thousands more excellent research articles coming out in the vitamin, herbal, Chinese medicine, every year, than any of us could possibly read. So, we choose those areas in life and medicine for which we are passionate, become good at them, and try to help people with that knowledge base.

Does this philosophy mean that everything outside my or your expertise ‘box’ should be called ‘folk-medicine’?

Perhaps we should not so quickly discount health ‘medicine’ coming down through the ages of time, from our grandmothers. I was warned about white sugar, white flour and processed food by my grandmother when I was a teenager. We smugly smiled, just short of mocking her. Only now do I realize how right she was! We tend to discount thousands of years of Chinese Medicine as ‘folk-medicine’, yet when the scientific studies are done, we discover how right they were-even millennia ago.

It only adds to the credibility of these thousands-of-years-old folk medicines that someone in the pharmaceutical industry will want to extract the ‘active component’, add a chemical group to it, patent it, call it a name, and sell it as if it were the plant from which it was extracted.

It is a travesty that the FDA limits the use of science in the marketing of vitamins and minerals and herbs, while permitting the drug industry to market their products blatantly in magazine ads and on TV (have you listened to the frightening lists of side effects that the spokesperson refers to at top speed in an undertone?). Vitamins have a track record of being far more healthy and beneficial, yet their advertisement is censored.

The delay in conveying known information about folic acid is a case in point. For 10 to 15 years it was well known that 800 micrograms of folic acid would prevent most of the spina bifida problems in the birth population, and during those 10-15 years, that information was suppressed.

Finally after countless efforts to make the knowledge accepted in “mainstream medicine,” obstetricians placed it within their ‘box’ and it was actively added to all prenatal vitamins.

In the last few years, a number of ‘orthomolecular’ products have been added to standard medicine, things we in ‘alternative medicine’ have been doing for 30 years-anti-oxidants for macular degeneration, fish oils for vascular/heart disease, niacin for cholesterol-lowering.

Credibility is very much an element of your point of view, and your definition of the word. Should credibility be defined as the prevailing majority opinion only, science based information only, thousands of years of proven worth only? Perhaps each of us must consider all our options, all our sources of information, and choose that course that is right for us at that time.

As for me, I’m choosing to listen to my patients, keep my mind open, and explore all options. It is the height of arrogance to assume that we know everything.

To your dynamic health and energy.
Stan Gardner, MD, CNS