Our
nation is highly polarized today, and often bitterly so. Democrats rail against the GOP. Pro-lifers face down pro-choicers. FOX News disses MSNBC. Isolationists push back against expansionists. Traditionalists disdain the politically
correct. Free marketers duel against government
advocates. Carnivores deride the gluten-free
crowd. Martin Bashir trashes Sarah
Palin, two proxies in a culture war.
There's a
philosophical divide among physicians also.
Would you prefer a liberal physician or a conservative
practitioner? I'm not referring here to
fiscal policy or legalizing recreational marijuana use. Consider the following hypothetical scenario
and the 2 physicians’ approach from opposite sides
of the medical philosophical spectrum. Which
physician would you choose?
Dueling Doctors
The
Patient: She is a 50-year-old female
with chronic fatigue syndrome (CFS). She
is only able to work part time because of her condition. She has consulted with an internist, an
infectious disease specialist and a naturopath, but her fatigue persists.
A new
treatment for CFS has just been launched by a reputable herbal supplement
company. Two well-designed studies
suggest symptomatic improvement in afflicted patients after 6 months of
treatment. As the product is an herb,
there is no formal Food and Drug Administration (FDA) oversight.
Physician
#1: "I'm reluctant to recommend this product, despite the optimistic
preliminary results from two medical studies.
These studies were funded by the herb company and there may be bias
present. Moreover, it is very typical in
medicine for initial results to be favorable, with unforeseen side effects and
complications emerging later when after more widespread use of a drug. I'm concerned that the FDA had no role in
validating that the drug is safe and effective for its intended use. Additionally, there is evidence that the active
ingredient in the product disrupts the immune system, which may have serious
future consequences that may not become manifest for several years or
longer. While CFS is decreasing your
quality of life, your condition has been stable and will never threaten your
life. I recommend holding off until we
have an FDA approved medicine for CFS or the herbal supplement has been used
long enough that we have a better sense of its safety and efficacy."
Physician
#2: "I recommend that you try this new herbal product. It is completely natural and showed promising
results in two medical studies.
Importantly, no serious side-effects developed in either study. Of course, we have no long term data on
safety, but the vast majority of herbal supplements on the market are
safe. No other treatment thus far has
been successful for you, and your condition is adversely affecting your
professional and personal lives. The choice is to try something new or to
continue suffering as you have been. Try
it for 6 months and then we’ll reassess."
So,
that's my herb blurb. This is a common
situation in the medical world where medical advice must pass through the prism
of Risks and Benefits. These analyses
are limited when the risks and benefits are unclear or disputed. Treatment acceptance also depends heavily on
the patient's risk tolerance. What if
the herb referenced above had a 5% risk of cancer? What if the herb needs to be taken
indefinitely? Clearly, when the disease
poses a serious medical threat, the patient may be willing to accept greater
risk of new or investigational therapies.
So, which
of these physicians would you choose for yourself? Are you a medical liberal or a conservative?
Physician 1 for me; one who is conservative in all things, please. We don't know how herbal supplements will interact with prescription medications, a patient's diet or habits, so an informed opinion isn't really possible. A nurse practitioner recently prescribed something new on the market. It is not a medication, but is only available by prescription, and is categorized as a "medical food". Her employer, my doctor, did not prescribe it, and had increased my simple calcium supplement instead. The medical food made me ill, and after ER treatment, I spent two days as an inpatient. I don't like the whole subject of supplements, herbal or otherwise, because they are unregulated and can be dangerous because no one really knows enough about their effects with combined with other things.
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ReplyDeleteNice and different article “Should doctor to be political in office?” I think doctor not be a politician in office. Doctor should be a doctor in office. That’s my thinking may be your thinking are against to me.