Andrew Weil raises a good question, but gives the wrong answer

Andrew Weil wrote a story for CNN today entitled “U.S. manages disease, not health“. He states that U.S. healthcare is too profit driven, which is true. He says the “right” question is: “How can we improve medical care so that it’s worth extending it to more people? In other words, how can we create a health care system that helps people become and stay healthy?”

He’s implying the obvious, which is that preventative healthcare needs to become more prominent in this country so that we have less disease to treat in the future. I don’t think anyone is really arguing against this philosophy, and just about all medical schools (including my own) are integrating this teaching in some way. However, is answer is absolutely wrong. He believes that “complementary and alternative medicine”, or CAM, is the solution. He quotes the NIH as describing CAM as a practice “for which there is some high-quality scientific evidence of safety and effectiveness”, emphasis is mine. I would argue that very LITTLE of CAM therapies have high quality evidence.

The reason why they are alternative therapies is because they lack evidence. Why does Mr. Weil believe the solution to cutting healthcare costs is by adding therapies which are not evidenced based. Probably because he is not a doctor or a scientist, and I wouldn’t be surprised if a CAM supporter has influenced him. To cut costs, we should push for even more stringent standards of practice using the highest quality evidence based medicine (EBM) available, and potentially reducing reimbursement for doctors that choose unproven alternative therapies that only increase costs without therapeutic results.

We should also push for even more teaching of preventative medicine within our medical schools and residency programs. We should make it more difficult to sue doctors so that there is less motivation to order unnecessary tests due to fear of litigation. Osteopathic (D.O.) schools could potentially lead the way on this due to their history of a philosophy of holistic care and the fact they’ve been early adopters of preventative medicine. Allopathic (M.D.) schools are moving towards this trend as well.

Andrew Weil seems to have good intentions, but his lack of understanding of CAM and EBM make for a poorly researched article with an ineffective solution.


The following is not something I ever expected to do in my life. Today I used a saw, the kind you use to saw small planks of wood by hand, to cut a person’s head in half, from back to front. That person was dead, he is my cadaver, but a person nonetheless. At the end, we were able to open his head up like a book, and close it the same. This was not some morbid thing, but an educational experience to better understand the otherwise hidden internal structures in the head. But, I couldn’t help but think as my saw was halfway through the face, that the timing of this lab, only a week or so from Halloween, was eerily fitting.

Hips and Feet

I wish I lacked some moral fortitude so I could post an excellent video of a student attempting to walk in front of the entire class in giant red high heels with a “hip amplifier” attached to demonstrate the motion of the hip joint. Possibly one of the funniest things to happen in med school so far.

Also, today’s lecture further confirmed that while interesting on a developmental and anatomical level, feet are still a little gross and I have no regrets ignoring all the e-mails I received from podiatry schools. Be happy I don’t feel like inducing nausea and vomiting in my minuscule audience by linking some of the slides we had the “pleasure” of observing today.

Homeopathy and Osteopathy

I was inspired to write this post after receiving an e-mail from a club at my medical school inviting people to a presentation on how “homeopathic Medicine can give YOU and YOUR patients an alternative (or compliment) to conventional medicine”.

Here’s a basic overview of the principle of homeopathy for those new to this topic from Harrison’s Principles of Internal Medicine 18th Edition:

Homeopathy was developed by Samuel Hahnemann, a German physician, who postulated that substances that cause particular side effects in a well person may be used to treat or prevent such symptoms in an ill person if administered in minuscule amounts—what is known as “the doctrine of similars.” For example, contact with poison ivy (Rhus toxicodendron) causes susceptible persons to experience an itchy, blistering rash. Homeopathy espouses the administration of highly diluted extracts of poison ivy to treat other blistering, pruritic eruptions, such as varicella.

I particularly enjoyed this line:

The relative decline of homeopathy relates, at least in part, to the field’s inability to articulate a rational mechanism that explains why products that are diluted more than 1060-fold, greater than Avogadro’s number, could incite biologic effects.

Another common example would be the treatment for insomnia. Homeopaths would suggest a dilution of the coffee bean. Coffee creates symptoms that can be similar to insomnia (restlessness), therefore they feel taking an INCREDIBLY small amount will remedy sleeplessness.

Maybe you’re like me, and this nearly instantly ignites the skeptic in you, and makes you wonder what possible scientific basis there could be for homeopathy. Or, maybe not. The point is that there is plenty of research to show that homeopathy is no better than placebo, which means that if it has any effect at all, it’s because you THINK it will have an effect.

Here’s some research:
  1. Ernst, E. (2002), “A systematic review of systematic reviews of homeopathy”, British Journal of Clinical Pharmacology 54 (6): 577–82
  2. Shang, Aijing; Huwiler-Müntener, Karin; Nartey, Linda; Jüni, Peter; Dörig, Stephan; Sterne, Jonathan AC; Pewsner, Daniel; Egger, Matthias (2005), “Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy”, The Lancet 366 (9487): 726–732
  3. Klaus Linde, Nicola Clausius, Gilbert Ramirez, Dieter Melchart, Florian Eitel, Larry V Hedges, Wayne B Jonas, Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials, The Lancet, Volume 350, Issue 9081, 20 September 1997, Pages 834-843, ISSN 0140-6736, 10.1016/S0140-6736(97)02293-9.
Here are few posts by Orac that do a much better job than I could dissolving homeopathy:

Your Friday Dose of Woo: The physics of homeopathy and “nanocrystalloids”

The Ultimate Homeopathic Remedy

Challenging Homeopathy

So, what’s the point?

Osteopathy already suffers a stigma of being “below” the allopathic or MD side of medicine. This stigma has steadily declined over time, and today osteopaths have nearly identical core training as our MD counterparts, and work in the same fields of medicine. However, when it comes to things like applying for residency training, bias still exists in some areas (especially in areas like neurosurgery and some other highly competitive specialties). Being in any way associated with a practice like homeopathy, even through hosting a lecture, only serves to give allopaths another reason to feel we aren’t up to par. I don’t think most osteopaths will subscribe to the belief that homeopathy has a proper place in medicine, but it doesn’t matter. Only a small percentage of osteopaths practice cranial manipulation, yet allopaths see that as a reason to look down upon the profession.

Homeopathy has no place in medicine, and that includes no place within osteopathy. If an “alternative medicine” club wants to invite people to their demonstrate of woo, they should do so off campus and without the support of faculty. Oh, I guess I forgot to mention a faculty member will be presenting, perfect.

Alpha Post

Part one: medical school

This is week 8 of medical school. I considered dropping out 8 weeks ago, but I won’t.

This is where I want to be, and what I’ve been working for since around 2004/2005 when I started figuring out that I wanted to be a doctor and not an engineer. I won’t give up, but I’m sure will feel like doing so many times during the next four years, and I won’t be alone. My class is around 200 strong, and as of today nearly half are technically failing anatomy.

Let’s get this out of the way: I knew what I was getting myself into. A rough estimate would be that I knew this better than many of my classmates. In addition to heavily researching medical school like every other pre-med out there, I worked in the healthcare field in EMS for two years and actively learned more about my field during that time. I’ve had countless conversations with doctors (M.D. and D.O.) about med school, shadowed plenty, volunteered plenty, talked to dozens of residents, and spent way too much time on SDN. That said, everyone that enters med school knows it will be hard. The problem is, there is a difference between knowledge and experience.

I risk appearing to be a complainer in my posts, I’m sure some will see it that way, and maybe they’ll be right. But, I hope to never lose my hold on why I wanted to do this and never forget this is a choice I made and wanted. I look at the med school site of this blog as just a way for me to talk out what I’m experiencing, if others are interested or can relate, cool man.

After 8 weeks, I feel like I’m in the ocean and fighting my best to keep my head above water. This is a weird feeling, because I am a damn good swimmer. Fact of the matter is, most of us in med school are damn good “swimmers”, and struggling is a weird feeling for any of us (I know, world’s smallest violin is being manufactured on a nano machine right now).

Okay, okay… enough intro, a little about my experiences thus far…

We’ve nearly completely dissect our generously donated cadavers, and our clothes stink of formaldehyde. There have been weird moments, like when you mistake the tibial nerve for the fibular nerve at first because your cadavers leg is on the wrong side of his body. Oops. Or, when your partner dissecting on the other side of the table slips while trying to muscle his way through fascia and fat, and splashes embalming fluid onto your face. That’s when you thank the professor that loudly emphasized to wear goggles. I believe this dissection has been highly valuable, and could not be replaced with a “virtual cadaver”, but I also cannot help but think these people had barely a clue as to what would happen to their bodies. You think someone told them students would casually examine their heart while their lungs were set outside their bodies on top of their abdomen to better visualize the vessels surrounding the heart? Probably not, but I also have yet to see someone be disrespectful to a cadaver outside not being an expert dissector (and how can you blame someone that’s never held a scalpel for that?). And hey, who cares if we accidentally transect the cadaver’s great saphenous vein, not like he was using it…

Part two: skepticism and osteopathy

The title of this blog as of today (and it may change) is “The Skeptic Osteopath” (though, I suppose more accurately, until 2015 add “ic Student” to the end). I’m sure some (especially hardcore osteopaths) will initially think “why did you choose to attend a D.O. school if you’re so skeptical?” The reason I chose to attend a D.O. school is pretty simple. It was in a location I liked, the students seemed to get competitive residencies, and I didn’t get into an M.D. school that was in a location I liked. That said, I am far from anti-D.O. I think learning physical palpation skills and some musculoskeletal techniques early will be valuable and put us a bit ahead of the game during residency and clinical rotations for our physical exams. I’ve spoken with more than a couple M.D. attendings that praise D.O.’s for their physical exam skills. However, I am anti-woo. I advice like-minded individuals to read one of my favorite blogs on this topic: Respectful Insolence.

The particular area of osteopathy that ignite the skeptic lightbulb is cranial osteopathic manipulative medicine. For those unfamiliar with this aspect of osteopathy, practitioners of “cranial” believe they can manipulate the fused bones of the skull, sense minute fluctuations in CSF (cranial spinal fluid) pressures through their fingers, and diagnose disease (such as diabetes) by a simple “laying of hands” on someone. Mainstream D.O.’s do not seem to believe in cranial, and there is very little evidence for, and good evidence against the technique. I hope to examine some research articles on this blog. The problem is that despite lack of evidence, and the supposed emphasis on “evidence based medicine” (EBM), cranial is still taught in most D.O. schools, and all D.O. students are tested on the topic on the most important exam in medical school, the Step 1 boards called the COMLEX.