Last week's show on Complementary Alternative Medicine (CAM) generated some predictably strong reactions against and for. Many of you are clearly in favor of CAM practitioners. But we were deluged by many of you for giving CAM the time of day at all. To read more, click on the button immediately below.
Let's begin with those of you who wrote in simply because you wanted to comment on something you heard.Joan Homer
of Vernon BC sent us this: "I am a clinical pharmacist at the B.C. Cancer Agency. I often talk with new patients before they start treatment or are deciding on treatment. The breast (cancer) patient you spoke to was taking ground flax.Ground flax is estrogenic.There was no mention in your interview if her breast cancer was ER/PR positive or negative. If positive, it is usually not a good idea to be taking products that push your body to make estrogen. My goal in talking to patients about all the medications they are taking is to help them make educated choices about their complementary medication."
Joan, you raise a critical point.In a portion of the interview not aired, Melanie Leppelmann, Christina Machado's naturopathic doctor, mentioned specifically that Machado is estrogen receptor/progesterone receptor negative. Hence, it's safe to recommend flax seed to Machado.
The B.C. Cancer Agency has a wonderful web site on Complementary/Alternative Therapies
. It's well worth checking out.Jill Shainhouse
a naturopathic doctor in Toronto, sent this email: "Hello, I listened to the piece where you interviewed Melanie Leppelmann and her patient. I know that you mentioned that she "specialized in cancer." Just so that you are aware, there are a number of board- certified naturopathic onclogists with a FABNO designation. This designation requires application to a board and further examinations in addition to the regular training of an ND. The application is only available to individuals who have spent several years in oncology research, doing a hospital residency in the U.S. or proving specialization over 5 years with a number of case reports. When treating cancer as an adjunctive therapist, I feel that it's necessary to educate the public on who the experts are in the field so that they can get the best possible advice. For more information visit the Oncology Association of Naturopathic Physicians' web site
, MD of Ottawa writes: "Regarding the woman who chose to have a naturopathic treatment instead of conventional therapy for her breast cancer: while I support her right to choose which treatments she accepts, I think that her choices also have impacts on the wider health system. It is important to remember that the health system is run for the benefit of all of us, and as citizens we have a duty to use it responsibly. It is less costly to the medical system to treat a condition early in its course, than to treat a recurrence. If she were to show up in the emergency room with a complication of her cancer that could have been prevented, is she willing to reimburse the health system for the cost of that care? Is her naturopath willing to treat a serious complication, or send her to the ER? Or perhaps her "expectant" treatment course results in more investigations, is it right that other people have to endure a longer wait time because of her choices?"Dr. Ian Phillips
of Edmonton writes: "Dear White Coat, Black Art, It's not a new publication but, biostatistician R. Barker Bausell's book Snake Oil Science: The Truth about Complementary and Alternative Medicine
, is an absolute tour de force evidence-based examination of the role of placebo in CAM. I think that an interview with R. Barker Bausell about his book and subsequent research in this field would be an excellent compliment to your most excellent show." A.J.Raffan
of Victoria sent this: "(As I) listened to your show about the naturopathic practitioners......the theme I kept hearing was that it was necessary to "manage" the medical doctors in order to get the tests the naturopaths required to monitor the treatment. I have been a nurse for more than 30 years and while I practised in education and administration for years, this story brought to mind my experience of practice as a new graduate. One of the first things we young nurses learned early on was how to manage the medical doctors to get them to give the orders the nurses felt necessary. I wonder why, all these years later, we still need to "manage" medical doctors? When will we truly have a respectful team providing the health promotion and illness care service necessary? Thanks for a good story!!!"Charles Leduc
of Vancouver posed this really good question: "I would like to know if an MD actually has the right to refuse treating a patient because he or she is using alternative therapies. To my mind that goes against the Hippocratic Oath, and is unethical. First of all most of those therapies are complementary which means they aren't meant to compete with allopathic medicine. Second, what would be the scientific grounds for refusal unless the doctor can show that it effectively conflicts with treatment? If that is simply the prerogative of the doctor than he or she could presumably refuse to treat for other reasons, say that the patient smokes or has bad eating habits! That said I am not one to advocate for alternative medicine instead of the conventional, as some of the more radical think. I use both to try and maintain my health as I well as I can. But one thing I have learned by the ripe age of 53 is that one can slow the aging process but one cannot reverse it."
Charles, for a good answer, I'll defer to a Policy Statement on Complementary/Alternative Medicine by the College of Physicians and Surgeons of Ontario
; the document calls on physicians to "consider whether any potential negative interactions may arise between the conventional treatment and the CAM treatment and take reasonable steps to assess whether a negative or otherwise adverse reaction may arise." There is nothing in that statement or in the entire document that approves of or condones the firing of a patient simply because they seek CAM.
Some of you had a favorable impression of the show. Joan Hughes
Ottawa writes: "Dr. Goldman, I wish to thank you for your open-mindedness, your fairness, and your intelligence. What a breath of fresh air! I go to the doctor once a year. Otherwise, I was told by her receptionist, I will be cut out of her practice. Years ago, my doctor realized that I would not agree to a drug-based approach to the things she identified as medical problems. I chose to investigate them on my own from a non-medical approach, despite dire warnings from my doctor. As a result, I have arrested or outright reversed and resolved issues that my doctor would have prescribed the following drugs for: Fosamax, Vioxx, Lipitor, all known to have highly problematic side effect. Furthermore, I have not had a mammogram in decades. Today, at the age of 69, I am grateful to be extremely healthy. I am not a medical doctor. I haven't had any training in medicine. So how is it that I could have been proven right, when my MD is considered to be the "expert" when it comes to health care. There is a very simple reason. I have the distinct advantage over my doctor NOT to have been trained by a system that is very much in the pocket of the pharmaceutical industry. Therefore, I can use just plain common sense, and common sense tells me that, if I got myself into a state of bad health, I can get myself out of it. I have done this by supporting my own body in its own built-in natural drive and ability to heal itself. Thus I have addressed my health on every level that we humans are affected by: physical, mental, emotional, and spiritual, and energetic. You may notice that I did not mention chemical. I have found that the take care of that all on its own if we rebalance it on all the other levels. If you would be interested in knowing which approaches I have found most helpful, I would really enjoy talking to you. I will mention two right here: The Body Code and German New Medicine. They are both outstanding approaches that work extremely well and very elegantly to help restore one to health!"David L. McCallum
of Ottawa sent this email: "In late 20s, I suffered from periodic and incapacitating lower back pain. No traditional therapies helped, and the back kept "going out". I was eating up my sick leave at an alarming rate. Luckily, I was introduced to the Feldenkrais Method by a registered physiotherapist and Feldenkrais practitioner. It turned out that she and I had the same family doctor; he admitted he didn't really understand what it was all about, but assured me that she wouldn't hurt me. That did it, and I took the plunge. She could see immediately how the exercises I was following so religiously had strengthened my muscles into a time bomb that was always going off. In a few months, I was not only pain- free, but resumed playing squash and other sports. I would have occasional recurrences, but got better quickly, and can now even treat myself, sensing when pressures build up, and what to do about them. The Feldenkrais Method is well known on the west coast, and is making inroads into the eastern North America."
of Kamloops, BC writes: "Thank you for the interview with the Naturopathic Doctor. I can't take any drug stronger than extra strength acetaminophen or ibuprofen. I hope that your program opened the views of other medical doctors; drugs aren't the only answer.."
of North Vancouver writes: "As usual, another interesting program. I suggest that you check out Inspire Health
in Vancouver. They deal with an integrative approach to cancer care which includes both allopathic and homeopathic approaches. There are MDs in the clinic, but patients also have access to meditation/naturopaths/massage/nutritionist, etc. It is quite a story."Faye Fergusson
of Toronto writes: "I think it is time that medical doctors work together with all alternative/complementary medicine doctors. I have been going to a naturopath for the last 10 years and I have informed my doctor that I am being treated by a naturopath. The reason I first went ...was because I was having severe stomach and digestive problems. I did the route of going to the doctor, allergist and also to a gastroenterologist. They could not tell me what was wrong but prescribed a pharmaceutical, which I refused to take since I do not like pharmaceuticals. I then went to a naturopath, told her my problems and she suggested I cut out certain foods. It became apparent I was gluten intolerant. I then had myself tested for celiac disease. Fortunately my gastroenterologist agreed with the naturopath that I probably had an intolerance and I should just cut out certain foods. Otherwise I am an extremely healthy person and I would like to stay that way. I would also like my doctor to work with the other people I have in my life trying to make sure I stay healthy, such as my chiropractor, naturopath, physiotherapist, and physical fitness program. Unfortumately I do not get shown any interest by my medical doctor in making sure that I stay healthy, only that I am not bringing him any serious problems. Needless to say I am looking for a new doctor, one who I hope will work with alternative / complementary care doctors."Jim Wright
of Edmonton sent this: "I think I'm a victim of this war without participating in it. Conventional physicians are often dismissive of 'alternative' 'fadish' diseases, one of which is wheat intolerance. I presented with moderate symtoms of celiac disease, (about nine separate symptoms) but my doctor looked at me skeptically and said he could tell by looking at me that I wasn't celiac. He gave me blood tests he claimed showed I wasn't celiac (but of course they couldn't do this because I was already on a self imposed wheat-free diet, the tests don't work unless one has a substantial amount of gluten in the diet). Several years passed where I got no treatment or even acknowledgement of my symptoms. Not till I developed severe dermatitis herpetiformis did an UK physician agree that I had DH and was therefore celiac. I made my gluten free diet more strict and my GI symptoms disappeared, my DH improved. My CDN physician since then (I now live in an isolated community) refuses to take my celiac condition seriously Some amazing quotes: 'There's nothing you can do about celiac disease, no one can keep to the diet' and 'You don't have celiac disease you no longer eat wheat'. Needless to say, I only visit this guy to get my cholesterol prescription renewed. Over several years I have endured moderate celiac symptoms (many who also have DH have reduced GI symptoms) and relatively severe DH (excruciating) . I am completely self diagnosed and self treated with the exception of the UK dermatologist. I believe this is almost completely because of several physicians who allowed their biases against 'alternative' diseases to get in front of their competence to do their job with real presenting symptoms. Please not that I am not a 'hypochondriac' who visits the dr often or who blows up minor symptoms. But I would like to have had some medical guidance over the years, all of which I've had to find on the internet. All I can say is, thank goodness for the internet.Thanks for your great program."Jane Palliser
of Victoria writes: "Hi Dr. Goldman, alternative health has to be addressed, especially for those living with chronic health problems. I was just reading the BC report on the cost of chronic disease and how it is driving the realization that 'alternative medicine' (for example, chiropractic) is the way to go to afford health care for those who are chronically ill. Having had endocrine problems for 35 years, I have struggled on my own to manage a lifestyle that presents the least challenges in order to manage my health.By the way I have had a very good GP, who has listened well, but I am learning as I move towards wellness products and philosophies that provide me with more options to take ownership for my health, I look back at 35 years and wondered why I was not moved by western medicine to these current options and was left powerless and uninformed about alternatives!. - I am angry that "Big Pharma" has monopolized the illness market by pushing drugs as the only option, even though they are 'regulated' -- the side effects in some cases, have also caused secondary disease and illness. Big Pharma has funded or subsidized medical schools and continues to present to doctors with incentives that they are the only choice for health. They do not necessarily make us better but have simply helped to perpetuate illness and to control our symptoms, without empowering us with options to wellness It is time to empower individuals and open up the concepts of health and wellness, but what a shame that the health authorities are starting to recognize the need simply because of the bottom line!"Deb Broomfield
sent this email: "Dear Dr. Goldman: this week's program hit home. I was diagnosed by my GP with fibromyalgia 15 years ago.He encouraged me to continue to exercise and suggested going on a low dose of anti-depressants.I could deal with the exercise but not the drugs so I turned to a doctor of naturopathy who spent considerable time documenting my symptoms and lifestyle patterns This led to me changing my diet - I try to eat as much organic fruits, vegetable and meats as possible and avoid pre-packaged food as well as switching to spelt products.I also take a considerable amount of supplements.For me, this has worked wonders I continue to work full-time as a server and volunteer as a fitness instructor at the Y. I did tell my doctor of my visits to a naturopath and he was quite negative so I have quietly continued on but wish I could have the support of the medical community. It would also be helpful if I could claim my purchases on my income tax form. I can afford to buy the product but it means I put less away for my retirement which is less than ten years away; however, I will be eternally grateful to my doctor of naturopathy for giving me quality of life."
Many of you wrote in to take issue with the program.Darlene Walsh
sent us this email: "Dr. Goldman; It was with great interest that I listened to your broadcast this morning dealing with naturopaths. It was also with great disappointment. I would have expected you to have provided your audience with some factual information on just what the educational background of someone who has studied naturopathy is and just what makes them think they are qualified to provide primary care to patients, beyond the title of doctor conferred on them by their own self regulating body. Some information on the course of study would be revealing, as I think mandatory semesters of homeopathy is enough said. We have a right to expect more of someone with the title of doctor than herbs and spices, magic water and sympathetic hand holding, as well as bogus allergy testing, fighting cancer with unproven diet advice, and immune system boosting supplements. Naturopaths do not have the education or clinical training of medical doctors, and conferring on them the ability to prescribe the right to order medical tests is just plain misguided if not outright dangerous for patient safety. The professionals at Science-Based Medicine
have written on this topic with much more authority than I, and I would respectfully suggest that you would do your listeners a much better service if you would present a more science based assessment of the services they are likely to receive from their local Naturopath. Or are these the 'Black Arts' to which the title of your show refers?"Len Buchanan
of Toronto sent us this: "Dear Dr. Goldman, I was looking forward to a program that exposed naturopathic medicine as a fraud to those listeners that want to know more. Complementary medicine that works is "medicine" and it should be put to the same rigorous evidence-based testing as mainstream medicine. Regarding Christina Michado's cancer treatment, you included the results of evidence based medicine when using radiation treatment - a 20 per cent probability of recurrence drops to five per cent with radiation. No such quote for green tea extract, mistletoe injections, or ground flax seed were discussed. So what are the statistics for those treatments? If they work, then they are "medicine" not "complementary medicine". As for the other patient, Wade Peckham, it sounds more like he had poor quality or incompetent treatment for his intestinal condition within the mainstream system. As for him being healed by the naturopath - show me the evidence - a set of one is not an acceptable study. There are many potential reasons for his recovery. In both cases, before you appease your listeners, you should find some randomized, placebo-controlled double-blind studies to support the naturopaths."
Len, thank you for your comments. Many of you expected us to expose CAM and were disappointed. You're entitled to your opinion. WCBA examines the system as it is -- and let's you decide what you think of it. There is growing acceptance of CAM in mainstream medicine. Recently, as reported reported in the Canadian Medical Association Journal
, Alberta became the fifth province to regulate Naturopathic Medicine. As mentioned above, the B.C Cancer Agency maintains a web site on CAM and how it can be integrated into cancer care.
I wanted to touch upon your comment regarding our specific mention of the risks of undergoing versus not undergoing radiotherapy. Your criticism made the point that not giving the risks of the herbal remedies demonstrated a deliberate bias in favor of CAM. In fact, I emphasized that Christina Machado had rejected radiation and what that might mean to her outcome. In emphasizing those facts, I was showing bias in favor of radiation therapy. Moreover, I challenged Machado and her ND Melanie Leppelmann forcefully on that issue and on the fact that she was opting for Naturopathic Medicine.Andre Lachance
of Thorndale, Ontario writes: "I was quite disappointed that....you suggested that physicians should open up to naturopaths. Why not homeopaths and chiropractors? A treatment either works or it does not. If someone can show that a naturopathic diet has improved the outcome of a cancer, they should come up and disclose the evidence. According to the "everyone has something to contribute" philosophy .....chemists should team up with alchemists, and biologists should encourage their students to learn creationism. When an alternative therapy is found to work, it becomes mainstream medicine."Ken Lord
of Vancouver sent us this: "I would like to know why the topics of science and evidence were not covered in this episode. The reason the methods of naturopaths are hogwash is because they are not based on science and evidence.They ignore prior plausibility, in some cases they ignore the most basic, most fundamental, and well understood laws of nature. For example: You can't be a naturopath unless you have been trained in homeopathy. If you think homeopathy has any more affect than a medieval bile chant, then please turn in your own shingle now. My impression from the interviews is that naturopaths leech off of people who don't understand or trust science and assuage their guilt by telling the really sick people to at least consult a medical doctor.Why were the cancer patients that were interviewed not informed that yes, the science-based methods have risks and don't always work, but there is no evidence to support the methods used by naturopaths, that the odds of the naturopath's methods working are far less and often zero? Why aren't naturopaths forced to prove their methods work? Why is it that so often the only proof they have is anecdotal or trials that lack proper controls and proper statistics? Yes, each person must decide what is right for themselves, but they can not make an informed decision when they aren't informed, when they are misinformed by the wishful thinking of naturopaths, or when they assume real doctors are hostile when they are actually presenting information backed by science. Why did you not mention the fact that naturopaths only receive very limited training, a small fraction of the training medical doctors receive, sometimes only two years? Of course they should not have access to labs and imaging techniques! They do not have the skills to interpret and act on the results! Why did you not look at the impact of naturopath professional organizations? They have been shown to not act in the public's interest. They do not act to advance the standards of their practice. They do not discipline members properly. They exist simply to control who can call themselves a naturopath and to create a false sense of authority to make up for not having science on their side. And the person who called it a "bad practitioner good practitioner issue?" Excuse me but ALL practitioners who ignore reality by denying science and evidence are bad practitioners. By definition this includes the vast majority of naturopaths because of the use of homeopathy and disproven herbs, supplements, and other methods.. Tell me, do you know of ANY case where a disproven modality was voluntarily removed from the standards of naturopathy? ... Trick question ... There are no firm standards! Alternative medicine that works is simply called medicine. The only advantage Naturopaths have is that they have more time to talk to people. In terms of real outcomes, if you look at the bigger picture, are the patients of Naturopaths more satisfied or more accepting of the outcome? Maybe. Do they more often die needlessly and prematurely while rationalizing away the fact that they could have made better choices? Absolutely. I hope no one suffers as a result of the shallow reporting and lack of critical thinking shown in this episode."
Andre and Ken, I wanted to focus on the point you raised regarding homeopathy vis a vis naturopathy. Naturopathic Doctors practice natural medicine. According to the Ontario Association of Naturopathic Doctors' web site, they are trained to treat ailments using clinical nutrition, acupuncture, botanical medicine, physical medicine, lifestyle counselling and homeopathy. Homeopaths, on the other hand, are trained to practise in one discipline - homeopathy. While Naturopathic Medicine is regulated and licensed in Ontario, homeopathy per se is not.
I think it's fair to ask NDs what evidence exists for the treatments they recommend, just as I think it's both fair and important to ask the same of physicians who practice mainstream medicine. Duncan Armstrong
of Halifax writes: "Hi Brian, I thought today's program was rather soft on its subjects; specifically, you did not address at all the 'two elephants' in the room. "Regular" physicians, and I am one, are not allowed, by strict regulation, to recommend that the patient purchase any treatment from them. All fees are paid by provincial medical plans, under regulation. The physician recommending chemotherapy cannot sell the chemotherapeutic agents. Alternative practitioners do exactly the opposite. I am suspicious of commissioned salespeople...because of the obvious conflict of interest. The law and governments agree, which is why doctors cannot sell drugs anymore. Secondly, you did not challenge the existence of all these supposed "research" studies showing the benefit of alternative therapies. I have looked, and looked again, as have Consumer Reports, the Mayo Clinic and on and on, and find no generally-accepted studies for the benefits of any natural therapy for breast cancer, for example. We all wish there were. Patients beware."
Duncan, you raise some good points. The issue of actual and potential conflict of interest exists with any health care provider who sells products at his or her clinic. Check out our Live Online Chat My Body, My Choice
for a lively discussion on this issue. Richard Tomkins
of Ottawa sent us this: "One of the worlds most filthy rich people, Steve Jobs, decided to practice his own medicine. He's dead now. He'd be alive if he'd done what his doctors counseled him to do and what his wife and children pleaded with him to do."
Richard, the arguments you raise have been well covered in Steve Jobs
, a biography by author Walter Isaacson. It was with his story in clearly in mind that I went after Christina Machado's choice and ND Melanie Leppelmann's treatment approach.
Ultimately, the final decision goes to the patient. The idea that patients assume personal responsibility for their decisions (risky and otherwise) is alien to most mainstream health care practitioners who work in a system that is decidedly risk-averse.
Coping with patient autonomy in the context of personal risk is an emerging challenge in health care. We will revisit this issue later this season on WCBA.
Thank you all for your thoughtful comments.