How To…

How to Talk to Your Doctor About Alternative Medicine (Part Two) – Six Questions to Ask

Continuing yesterday’s topic, let’s take a closer look at how to talk to your doctor about alternative medicine.

First, let me preface this with a few thoughts about talking with medical professionals in general.

When I schedule a “get acquainted” or first-visit appointment with a new doctor, I ask for extra time to discuss the doctor’s views on practice. I bring a list of questions – sometimes two copies, one to hand to the doctor, one to keep and jot notes on as we discuss the questions – and treat that part of the appointment as a job interview in which I’m the hiring manager.

That may seem strange to some.  After all, it wasn’t long ago that doctors were perceived as nearly godlike figures to be respected, revered, and obeyed but never questioned. Today, as medical professionals and medical schools recognize the importance of cultivating a partnership between doctors and patients, attitudes on both sides have changed.

You may not know which signs and symptoms indicate which diseases, as the doctor does. You may not know which medications have been proven most effective for which conditions, as the doctor does. But nobody knows how you feel better than you do, and nobody knows what’s normal for you and your body better than you do. You’re the CEO of your health and welfare. Medical professionals advise, but when it comes to your health, you make the decisions.

You wouldn’t hire a plumber or electrician or heating contractor or automobile repair service without asking about qualifications, areas of expertise, and attitudes that could affect the job he or she could do. Why not approach that first doctor-patient partnership interview the same way?

 

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Ready?  Great. Now let’s look at SIX QUESTIONS to discuss with your doctor when you have The Talk. To help spur ideas, I’ll include samples of good answers that can lead to productive discussions with your doctor, and bad answers that lead to dead ends.

1. What is your opinion of alternative medicine?

Good answers:

* It depends on which treatment you’re talking about; some have proven successful in studies; others are useless or dangerous.

* I am open to treatments that are backed by scientific research.

* I haven’t given it much thought but am open to discussing it.

Bad answers:

* No.

* Alternative medicine is nothing more than a modern version of the old time snake oil scams.

* What’s that?

2. How knowledgeable would you say you are about alternative medicine?

Good answers:

* I have read several studies about it.

* I have attended a few conferences and presentations.

* I keep up with the latest research and reports on it.

Bad answers:

* Zero. I know next to nothing about it and am not interested.

* I’ve heard of it.

* I know someone who believes in that stuff who is a total nutcase.

3. Have you ever recommended an alternative medicine treatment?

Good answers:

* Often.

* A few times, when it seemed appropriate.

* It has not come up yet but I would if it seemed right for a patient and the patient wanted to try it.

Bad answers:

* Never.

* Anybody who wants that woo-woo-world medicine should go to a witch doctor, not me.

* Why do that when we have drugs and surgery?

 

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4. Will you look into a treatment if I want to try it?

Good answers:

* Yes.

* Yes, if you tell me why you want to try it and what credible information you have about it.

* Probably. If I think it has some merit, yes, but if I know it doesn’t work or is fake, I will tell you that and won’t waste time researching further.

Bad answers:

* No.

* I have better things to do with my time.

* I wouldn’t know where to look.

 

5. What if I you recommend a prescription and I prefer to use a supplement, or you recommend a conventional treatment that I refuse in favor of an alternative treatment?

Good answers:

* As long as your health was not in danger and you keep me posted and come in for regular checks, I would go along with that.

* I would tell you what I think and recommend but it’s your body and your decision.

* If it is safe and it works for you, it’s fine with me.

Bad answers:

* I expect my patients to follow my recommendations or go elsewhere.

* I would tell you to take the prescription, period.

* I will mark your chart “patient is non-compliant.”

6. Would you write a referral if I needed one to have an alternative medicine treatment?

Good answers:

* Yes.

* If I know anyone to refer you to, I would.

* It may not always be possible but I would if it is possible.

Bad answers:

* No.

* I only make medical referrals.

* I don’t know any quacks and would not send my patient to one if I did.

Bottom Line:  These questions and variations have worked well for me. Fortunately, most of the doctors I’ve talked to have been very pragmatic about alternative medicine. And being open-minded and willing to discuss the topic is a good start. 

I don’t expect them to know all the answers – whether we’re talking alternative medicine or conventional medicine – but as long as they’re willing to discuss options and research what they don’t know, I think we will be able to work together as partners to find the treatment that works best for this patient.

Comments are very welcome… let us know if you would use different questions or add new ones to this list.

© 2012, All rights reserved

 

(Images courtesy of Microsoft Office Clip Art)

 

 

 

 

 

 

How to Talk to Your Doctor about Alternative Medicine (and why you should) – Part One

 

Have you ever talked to your doctor or primary care provider about alternative medicine?

Do you know what your doctor thinks about alternative medicine in general, and specific remedies in particular?

Have you ever discussed the supplements you’ve decided to take or asked your doctor what supplements he or she recommends?

Do you know if your physician would recommend that you try massage therapy or take a Tai Chi class or send you to an acupuncturist? 

If you asked for a referral for massage therapy, Tai Chi, acupuncture, or another AltMed practice, would your doctor okay it? 

Don’t know?  Now is the time to find out, and the best way to do that is to ask simple, direct, and straightforward questions.

 

Sounds easy, doesn’t it?  “Just Ask.”  All you have to do is just do it, right?

And yet, somehow the prospect of actually taking this step – actually asking your doctor what he or she thinks about AltMed – turns many people into stammering excuse-generators who justify inaction with comments such as:

Sure, I’d like to but he’ll be mad at me

I wouldn’t dare – he’ll think I’m stupid… or, worse, crazy…

She’ll say only quacks go in for woo-woo world stuff…

If I did that, she’d never take me seriously again… 

He wouldn’t know anything about that, I’m sure, so why bother?

 … And a gazillion or two other I-can’t-because reasons for avoiding the issue.

 

If that’s you, here’s a News Flash:  You may be pleasantly surprised to discover your doctor is more open-minded than you thought and DOES have a working knowledge of alternative practices such as acupuncture, vitamins, herbs, meditation, chiropractic, and recent research findings about their safety and effectiveness. Having The Talk could lead to you getting better and more well-rounded care.

Many of the tools and resources doctors use do include information about herbal therapies, vitamins and minerals, and other AltMed treatments. Devices such as smartphones, instant Internet access laptops and tablet computers, and other communication tools help keep doctors up to speed on topics they might otherwise miss, including AltMed topics.

 

There’s a good chance your doctor will be in the open-to-the-idea camp. After all, acceptance of alternative medicine practices is growing rapidly as research provides more and more evidence of effectiveness for many AltMed treatments.

 

But, suppose your worst fear comes true. Suppose your doctor does get mad. Suppose she does say anyone interested in alternative medicine is stupid or bonkers? Suppose he dismisses all alternative medicine as snake-oil and quackery? Suppose she simply doesn’t know a thing about it. Suppose…well, fill in the blank with whatever negative reaction is behind your hesitation to ask.

If that really is how your doctor would react, you have to ask yourself if you really want this person to be taking care of your health. Is this the type of person you really want to be your doctor? 

If he or she is unwilling to discuss alternative medicine with you, how can you discuss other sensitive issues that need to be discussed? 

 

Do you really want to put your health in the hands of someone who can’t or won’t take your questions and concerns seriously enough to discuss them with you in a fair, frank, adult manner?

Can you put your trust in a doctor who doesn’t know as much as you do about the type of care you’d like to receive?

You can easily guess what my answer would be, but what is your answer?

Tomorrow we’ll talk about what questions to ask (when you have “The Talk”). 

Questions, anyone? Comments?

© 2012, All rights reserved

More Tips on How to Evaluate “New Study” Research

 

Yesterday, we looked at how to evaluate “new study” research and we focused on the gold standard type of study, the placebo-controlled, double-blind, randomized multi-center trial.

The randomized controlled trial, or RCT for short, works well when the goal of the study is to find out how a new drug or new treatment stacks up when it is compared to a placebo or to an existing drug or treatment (i.e., something that is already being used to treat the same condition the new item is designed to treat).

But RCT is not the only type of study. Other types may be used at different stages of research to achieve different goals.

The starting point is an idea or finding in basic research.

Suppose, for example, there is a scientist somewhere whose lab work involves enzymes and one day he is thinking about how lactose enzyme replacement products make it possible for people who are lactose intolerant to eat cheese without suffering the bloating, gas, cramps, nausea, and diarrhea symptoms lactose intolerance can cause. And that makes him think of the guest who was sober when he arrived at the office holiday party but appeared drunk after just one beer…  Wouldn’t it be great if people like that guest whose bodies don’t metabolize alcohol normally could take an enzyme replacement like the lactose intolerant person can, the imaginary scientist thinks… If we could identify an enzyme that is different in the alcohol-challenged person’s body compared to a normal body, maybe that could lead to treatment for alcohol overdose or alcoholism…So our imaginary scientist thinks about which enzyme should be targeted for study and figures out a plan of action to test the idea by doing “test tube” research the lab.

His idea will go through several steps of research, first to see if it has enough merit to continue studying it, and then to see if it works, and then if it works – and how well it works – on real people.

There are seven primary types of study that begin with lab and animal studies and  move up through the seven levels of study that form the pyramid “hierarchy of evidence,” according to the Introduction to Evidence-Based Medicine website and similar resources.

  1. At the bottom of the pyramid are lab studies and animal research, the foundation on which other research is built.
  2. Case series and case reports come next, forming the sixth level.
  3. Level five is case control studies.
  4. The fourth level is cohort studies.
  5. On level five: randomized controlled trials.
  6. Next to the top is systematic review at level six.
  7. And the peak of the pyramid, or level seven, is meta-analysis.

Those levels are useful for scientists to understand and they’re helpful for us to know but often the key factors we need to consider when you and I look at medical studies to decide whether their findings apply to us or not are a little simpler.

Here are some of the keys I look for when I read about new studies:

  • Was it was the study done in the lab or on animals?  That level of research is interesting and is a fundamental step to build on but more research will be needed to find out whether it may apply to humans. Bottom line: It may be promising but it’s not something we can use now or soon.

  • If the study was done on people, how similar are we to the groups who were tested? For example, a study of marathon runners and people aged 18 to 30 who run at least 20 miles each week will be applicable to others in the same age group whose exercise levels are comparable but not so applicable to arthritic seniors in their 70s who can barely manage to walk 7 miles a week.

  • How big was the study?  And did it last long enough to draw the conclusions the researchers are making now? The larger the number of people tested, the better. There can be good reasons for limiting the number of participants in a study and the information small studies provide can still be useful, but as a general rule, bigger is better.

  • Was the study done at or by a qualified facility, ideally one that has expertise in doing this type of study, such as a large medical school or university hospital? 

  • Was the study funded by a company that makes the product that was tested or did the researchers disclose any affiliations with such a company? The best answer would be ‘no.’

  • Did the researchers look at the right data? For example, some reports say studies testing certain herbal remedies were doomed to show the remedy failed because the researchers tested the wrong dose, the wrong form, or the wrong method of administering the remedy instead of testing it using the form, dose, and method recommended by herbal medicine experts.

  • Was the information the study collected or examined or analyzed actually useful? Some of the comments posted on public forums responding to news of the recent study that found calcium may increase heart attack risk noted that the study did not identify what type of calcium supplement the study participants took (that one factor can make a big difference), and also didn’t have firm data on how much of the supplement people took how often for how long. The researchers did have people’s recollections of what they’d taken, but is memory reliable enough?

  • Did the study or the researchers seem to have an agenda? Does it look as though the study was done not to gain information but to confirm an expected outcome? And if it was set up that way, was that appropriate?

Do you have other questions you would add to this list? Please share them via the comment feature on this page.

To learn more about types of medical studies, take a look at these sites:

Study Design 101

Non-randomised controlled study designs

Understanding Medical Research

Tips for how patients can evaluate health research

SUNY Downstate Medical Center’s EBM Tutorial Guide to Research Methods

 

© 2012, All rights reserved.

Tips to Help You Evaluate “New Study” Research

How often have you read articles that report on the findings of new research “Study shows that…” “New research raises questions about… “According to the authors of a new study…” or “Study finds …” ?

Readers of this blog have seen variations on those phrases many times because one of our goals here at AltMedForYou is to report on new research that involves any aspect of alternative medicine.

Publications like to use the word “study” in headlines because it adds credibility and importance to whatever they’re reporting. But there are many different kinds of studies, and they’re not all equally useful in terms of applying the findings to you and your health concerns.

That doesn’t mean that the studies that are not directly applicable to you are no good or that they should be ignored. It just means that they don’t fit you.

What’s the best? For drug testing, that would be a placebo-controlled, double-blind, randomized multi-center trial, which many experts have told me (in interviews for other articles) is widely considered to be the “gold standard” of medical research. It is an excellent way to test new medicines. 

Let’s break that down to see what the name means:

* placebo-controlled tells you that some patients in this study were given a placebo, or what some call a “sugar pill” or “dummy drug,” instead of the real drug the study is testing, while others receive the real drug. Ideally the placebo looks so convincing that neither doctors nor patients can tell which is which.

 

* double-blind means that neither the doctors (or other staff involved in the study), nor the patients participating in the study know who is getting the real drug and who is getting the look-alike placebo. (Think of it as putting a blindfold on both the doctors and the patients, with no peeking allowed.)

* randomized means that selecting which part of the study each patient will be assigned to is done on a random basis, without influence from the people running the study, the patients participating in the study, or the doctors and other medical staff involved in treating those study participants. Participating in a randomized study is like going to a potluck supper—you get a meal but nobody can pre-select what will be on your plate.

* multi-center means, as the name suggests, that this study was done at several medical facilities which many be in multiple cities and states. That can be a good way to eliminate any regional factors that might otherwise color the test results.

 

There are many articles online that give concrete tips and how-to information to help you judge whether a study is valid or not. Here are two samples … more to come tomorrow.

 

What makes a research study valid

How to determine the research validity of a research analysis

(c) 2012, All rights reserved

What Makes an Alternative Medicine Source Credible (or Not)?

 

The wonderful thing about having access to information on the Internet is that everything you want to know or could ever want to know is “out there” somewhere. It may be easy or hard to find, depending on how obscure it is and how well you use search tools, but odds are the answer is there, somewhere.

 

And the not-so-wonderful thing about it is that everything is out there, whether it’s valid or false, useful or frivolous, sincere or scam. Sometimes it’s easy to brush off the baloney, weed out the wacko, and spot the scams. But not always.

 

That’s why it’s important to think about what signs to look for before you believe (or buy) what you find online.  Conventional health and medicine websites may display the HON (short for Health On the Net) Code  symbol, which tells you the site has gone through a fairly stringent vetting process and passed. I can’t recall seeing the HON Code on an AltMed site but if I found it on one, I’d consider that site trustworthy.

 

But even without such a clear cue, other signs can tip the balance toward or away from credibility. Here are a few of my “red flags.”

  • Too much hype. Enthusiasm is fine but when an email or post or website that raves too enthusiastically about how wonderful a supplement or treatment or product, it casts a big shadow of doubt. If the item – whatever it may be – is really THAT fantastic, why do you have to push it so fervently? Can’t it stand on its own merits?  If facts and evidence show it really does what the hype claims, that goes a lot further to convince me than shouting and touting it with slick sales spiels.

 

  • Selling. It’s disappointing to discover an otherwise promising report about a supplement, product or device, book or treatment is really just fancy packaging for a sales pitch. If the person or group that created that report weren’t selling the item, would they still praise it so highly? 

 

  • Secrets “they” don’t want you to know. If this really is true, how did this report manage to sneak past the mysterious “They” who don’t want us to know about it?  And how did the author of this article or email or web page get past “them” to discover this “secret” information? To me, that “secret” tag means “be skeptical.”

 

What are your red flags? What tells you that you can trust what you’re reading? Please share your comments and we’ll revisit this topic in the future.

 

 

© 2012, all rights reserved

Acupressure Tap Technique

 

Acupuncture can be a wonderful remedy for many conditions. It’s one of the oldest healing practices in the world.

 

Studies investigating its effectiveness for knee pain, lower back pain, cancer pain, alcohol addiction, chronic stress, polycystic ovary syndrome, asthma, allergies, and other ailments have been mixed, according to Research Results posted on the National Center for Complementary and Alternative Medicine website. 

 

How it works:

 

A trained acupuncturist inserts super-fine acupuncture needles at “meridians” or acupuncture points where energy flow may be blocked or stagnant to elevate spirits, ease pain, and promote healing. The needles are so thin that they’re barely noticeable when inserted just under the skin.

 

There’s also a no-needle version called acupressure that works on the same principles, but instead of using needles to stimulate acupuncture points, pressure is applied with fingers, thumbs and hands. 

 

Yet another variation uses tapping instead of needles or fingers to activate the same acupuncture points. It’s designed for do-it-yourselfers—people who want to learn how to use these techniques on their own to manage their own health concerns.

 

If you’re interested in trying it, check out the 20-something how-to demonstration video that expert Gina Green has uploaded to YouTube.com. They show  exactly how to use the techniques for various problems. Green’s  instructions are clear, direct, and easy to swallow.

 

I believe many of her techniques work. What do you think?

 

 

 

© 2012 all rights reserved.

Before you start taking that supplement

 

If you’re thinking of starting to take omega 3 or any new supplement that you haven’t taken before or haven’t taken recently, take time to become an informed consumer.

 

Do your homework.

  1. Read as much as you can about the supplement – pro and con – before you try it.  Know what conventional medicine says about the supplement as well as what alternative medicine says. You’ll find information in loads of health and nutrition books and magazines, brochures, single-sheet supplement handouts about individual supplements (free at health stores), and similar sources.
  2. Check reputable websites.
  3. Ask staff at your health store. Some health stores make sure all the people who work in their stores, especially those who talk to customers, are well informed and able to answer questions. Many also have nutritionists and other experts available for consultation.
  4. Consult a pharmacist. If you don’t have a pharmacist, go to a large drug store or grocery with in-store pharmacy and ask to speak with a pharmacist.

 

Learn as much as you can about the supplement.

  • Find out what the risks may be.
  • Find out how much to take. You should know both the recommended dose and the “ceiling” or do-not-exceed maximum dose
  • Find out how to take it. Some work best when taken with food; some should not be taken with food. Some may interfere with absorption of other supplements you take (such as iron and calcium, for example); others help your body use the supplement more effectively (such as iron with vitamin C). Some are better at bedtime; others at morning. And so on.
  • If you take any medications, find out if the supplement

 

Write it down.

If you don’t already keep a supplement record start now.  Call it a journal or a diary or a log or give it whatever label you like – just do it. 

Include:

  • Reason?  Say why you are trying this supplement. What do you hope it will do for you?  Many supplements have multiple benefits. If that’s true of the one you’re going to try, list the primary reason first, then note any secondary goals that are important to you. For example, if you were going to start taking Cosamin DS, a glucosamine-chondroitin supplement for joint pain, your Reason entry might say: Reduce hip pain. Move easier. Walk longer.
  • Date?  Date you start taking the supplement. If time (of day) taken matters with this supplement, note both date and time.
  • Dose?  How much are you taking? How often?
  • With?  What other supplements and/or medicines do you take on the same day you take the new. If the supplement is one of those that should be taken with food or on an empty stomach, note “with meal” or “empty stomach” and if it should not be taken at the same time as something else you take, note the times (when you took this supplement and when you took the other supplement or medicine)
  • Changes? Make a note of any changes you notice. Include improvements, even if you are not sure they’re related to the supplement, such as “memory better” … “legs didn’t ache like they usually do after long walk” … “not out of breath now”…  Also note any problems or concerns, such as “1st bloody nose since 4th grade” … “bruise easily” … “rash won’t go away…” “very tired but getting plenty of rest". 

 

You don’t have to make notes in your supplement log every single day, but do update it whenever you make any change or notice anything new. Keep making notes for at least six months.

 

Why so long? Some changes are so gradual or so subtle that they go unnoticed. Some may not show up until you’ve been using the supplement for several weeks or more. Some are like pieces of a jigsaw puzzle in the sense that one individual piece doesn’t show much but when added to other pieces (when you review your notes), patterns emerge or become more apparent.

 

Having a written record will cover any gaps that might creep into memory and also will make it easier to see “the big picture” to assess how this supplement is affecting you.

 

 

© 2012, all rights reserved