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FDA-Approved Drugs Are Not Always Effective: The Benefits Of Alternative Medicine

St-Johns-wort

On Saturday, while thousands of Boston Bruins fans gathered at Government Center to celebrate the team’s recent Stanley Cup victory, a hundred or so true die-hards met a few blocks away at a Massachusetts General Hospital conference to talk about complementary and alternative medicine for psychiatric disorders. While I hated to miss the Bruins parade, I’m glad I attended the MGH conference.

I’ve always been a bit of a skeptic about so-called natural therapies for one simple reason: they don’t have to go through the same rigorous testing in clinical trials that medications do. At the same time, I realize that FDA-approved drugs don’t work for everyone. One in three adults with major depression, for example, can’t completely improve their mood and other symptoms even after trying multiple antidepressants.

Clearly, we need better options for treating mental health disorders. The MGH conference convinced me that some types of complementary and alternative medicine—or CAM, for short—might be worth trying. The presenters, all psychiatrists who treat patients at MGH, backed up their recommendations with scientific evidence. Several of them also contributed to the American Psychiatric Association’s recent report on CAM therapies.

We’ll be doing a story on CAM therapies for psychiatric disorders in an upcoming issue of the Harvard Mental Health Letter. For now, here are some things I learned on Saturday: Read more »

*This blog post was originally published at Harvard Health Blog*

Homeopathy: Why is Fraud Legal?

Imagine hearing a commercial on the radio:

Send us money, and we won’t send you anything in return.

No one would do that, right? How about this:

Send us your money and we’ll send you an empty box.

Better? Not much. Now how is that different from:

Send us money and we’ll send you stuff we’ll call medicine that we claim will help you, but there’s no actual active ingredients in it at all.

I don’t think there’s one bit of difference. Wouldn’t you agree that that commercial is fraud, pure and simple? The problem is that the general public doesn’t understand that the word “homeopathic” means “diluted beyond the point where it contains any active ingredients.”

I’ve recently heard commercials for homeopathic vertigo treatments, eye drops for allergies, irritable bowel, and spider veins on legs. I’m tempted to contact the radio station and complain, but stopped short realizing that their first question is going to be, “But is it legal?”

That’s the problem: it is. So what I want to know is, why? Read more »

*This blog post was originally published at Musings of a Dinosaur*

Complementary And Alternative Medicine Can Be A Regressive Force Against True Science

Science is a philosophy, a technology, and an institution. It is a human endeavor- our collective attempt to understand the world around us,  not something that exists solely in the abstract. All of these aspects of science have been progressing over the past decades and centuries, as we refine our concepts of what science is and how it works, as we develop better techniques, and organize and police scientific activities more effectively. The practice of science is not relentlessly progressive, however, and there are many regressive forces causing pockets of backsliding, and even aggressive campaigns against scientific progress.

So-called complementary and alternative medicine (CAM) is one such regressive force. It seeks to undermine the concepts, execution, and institutions of medical science in order to promote sectarian practices and ideological beliefs. Examples of this are legion, exposed within the pages of this blog alone. I would like to add another example to the pile – the recent defense of homeopathy by Dana Ullman in the Huffington Post (names which are already infamous among supporters of SBM). Read more »

*This blog post was originally published at Science-Based Medicine*

Warning: Dr. Mehmet Oz Is Not A Trustworthy Source Of Health Information

When I was in medical school at Columbia University College of Physicians and Surgeons, Dr. Mehmet Oz had the reputation of being a competent and caring cardiothoracic surgeon whose research interest was reducing preoperative stress. I remember hearing about a music study of his in which soothing melodies reduced blood pressure and heart rates in patients preparing for heart surgery. I felt pleased that a surgeon was leading the charge in improving patients’ O.R. experiences, and had no inkling that 15 years later Dr. Oz would be America’s chief snake oil salesman.

I have been slow to criticize Dr. Oz on my blog because of a sense of loyalty to my medical school, however yesterday he crossed the line when things got personal – a friend of mine was negatively impacted by his misinformation to the point where her life was endangered. From watching his TV show, she was led to believe that she would put herself at risk for thyroid cancer if she got a mammogram. Several of her relatives have had breast cancer, and she should be particularly vigilant in her screening efforts. However, because Dr. Oz said that mammograms may themselves cause cancer, she opted out of appropriate screening.

My colleague Dr. David Gorski at Science Based Medicine has done an excellent job of documenting Dr. Oz’s almost Charlie Sheen-like career descent. Although he began his work as (presumably) a science-respecting surgeon, he now spends a lot of his time hosting a TV show that features faith healers, anti-vaccinationists, and psychics.

But how does the average lay person know how to evaluate Dr. Oz’s health claims? When Oprah’s network promotes him as “America’s physician” the platform itself offers him credibility, and a reach that can damage and misinform millions like my friend. I have a feeling that many of my peers at Columbia are concerned about Dr. Oz’s promotion of quackery, but once they’ve invested in his brand for so long, it’s easier to turn a blind eye to his nuttiness than to oust him from his academic positions. At what point is a celebrity doctor doing more harm than good to an institution’s reputation? Is he now “too big to fail?”

But back to my main point – dear readers if you watch Dr. Oz and think that he’s a credible source of health information, please be aware that much of what he says is inaccurate, exaggerated, and based on mystical belief systems. Please don’t act on his advice without checking with your own physician first.

Sadly, good science doesn’t always make good television. But the truth can make you well. Be warned that you are unlikely to find the truth consistently on the Dr. Oz show.

Don’t Believe The Hype: Acupuncture And Alternative Medicine Are Not So Popular

Everybody’s Doing It

One argument that often comes up when skeptics and proponents of so-called complementary and alternative medicine (CAM) debate is the question of the popularity of various CAM practices. Advocates of CAM often claim these practices are widely used and growing rapidly in popularity. Obviously, CAM proponents have an interest in characterizing their practices as widely accepted and utilized. Even though the popularity of an idea is not a reliable indication of whether or not it is true, most people are inclined to accept that if a lot of people believe in something there must be at least some truth to it. The evidence against this idea is overwhelming, but it is a deeply intuitive, intransigent notion that can only rarely be dislodged.

It might therefore be useful to get some idea of whether or not the claims of great popularity for CAM treatments are true. If they are not, fruitless debates about the probative value of such popularity could potentially be avoided, and it might be possible to diminish the allure associated with the belief that “everybody’s doing it.” Read more »

*This blog post was originally published at Science-Based Medicine*

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I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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