Last night, while packing...
Everyone wanted to get in the case hehe.
Milly and I are having a good day today! Hit the gym this morning (I almost died) and then went to meet a friend for brunch!
My pancakes with macadamia ice-cream! My friend Judy had the lobster roll.🦞
Then I went to pick up my new computer.
It’s the 12-inch MB in gold! Weighs only 920 grams - I’m in love!
(Photo from Apple)
(Photo from Apple)
My first Apple computer, even though I have an iPhone and iPad...I’ve always had a PC but now it’s on its last legs and I am about to start some research on prostate cancer, and study for my professional exams in 2021.
Going to feed M, take the dogs out, set up the new computer and then head to my friend’s for dinner!
Complementary and alternative medicine (CAM)
So back when Milly was a couple of weeks old, and diagnosed with a tongue tie, the maternal child health nurse we went to see suggested (without knowing about my job) that I take her to see a chiropractor for it.
She went on to say, “The medical community doesn’t really believe in chiropractic care.” To which I then responded, “No, we don’t.” She then realized that I was part of that community and never spoke of it again.
But I was angry.
Here is why: had I not known any different, I might really have taken her advice and brought M to see a chiropractor, simply because it was recommended by a nurse, whom most would regard as a person of authority whose advice can, or even should, be heeded.
Now, firstly I should put it out there that I am a firm believer in evidence-based medicine. That means that any therapy/method/medication is put to the test by the scientific method.
In the most basic of explanations: this method is carefully planned to have as little bias as possible, has to pass ethics approval to go ahead, and is then performed stringently. The results are then put through various statistical analyses to see if they are significant, then the entire thing is reported, and if it is high-quality enough, it is published in medical journals and then it guides the way medicine is practiced.
This is how Western medicine works, and I like it (which is why I went into it!), because it is a systematic approach to know whether any given therapy, method or medication works, what the side effects are, and what the general consensus is on using it.
It is based on evidence, and while far from perfect, I think this is the best we can do.
CAM such as traditional Chinese medicine (TCM), chiropractice, osteopathy, naturopathy and homeopathy are largely non-evidence-based forms of healthcare (hence the “complementary” and “alternative”). They do not generally undergo the same research methods or studies, and as such, there is very little evidence that says that they work, or what their long-term or side effects are.
Now, that is not to say that they don’t work. They might. I don’t know. No one knows, because there haven’t been enough studies or research put into these areas.
What we also don’t know, more significantly, is what the side effects or risks are, from CAM. And I think this is very important.
Medicine is a delicate balance of risk versus benefit. Every time we want to intervene, be it through an investigation like a blood test, or an X-ray; or a treatment such as medication or surgery, there is always, always a risk. We go ahead only when the benefit outweighs the risk.
So you take the medication...because not taking it would be far worse than taking it and experiencing its side effects; you go through with the surgery...because removing the tumour is life-prolonging, and improves your quality of life in the long run, despite the pain, infection and anaesthetic risks.
But my point is, there is always a risk. There also may be a benefit.
And if I am going to make this decision of risk versus benefit, to help guide my choice, then I would want to know as much as possible about each.
That is why evidence-based medicine is so important.
CAM is like going in blind. There has been so little research done that who really knows what the benefits or risks are. Can a coffee enema really cleanse my large intestines? Are there any risks of flushing coffee up my anus? Who knows?
And yet I find that many people don’t question the biological plausibility of CAM methods and treatments, or think about how CAM can so confidently make the claims they do. Don’t you want to know the science behind it? The reasoning? How it works? The evidence?
“But my aunt went to a chiropractor and her eyesight improved.”
“My friend took TCM and she felt better.”
“MIL followed a homeopathic remedy and her headaches disappeared.”
This is what we call anecdotal evidence, or “someone I know did it and it worked”. It is flawed reasoning and can’t be used to prove anything, simply because there are too many variables and no control.
Let’s say you want to compare the prices of milk powder across brands. You need to make everything as similar as possible to have an accurate comparison. For example, you would want to compare the cost per 100g of milk powder at the full price of each product. You would not compare the price of 80g of Brand A with 90g of Brand B with 300g of Brand C at 10% discount. You only want one variable, which is the brand of milk powder.
In that same way, anecdotal evidence is not accurate because there are so many variables between your aunt, my MIL, your friend, my husband and our various and sundry relatives. They are different ages, genders, races...they might have various pre-existing conditions...some might be taking this medication, others might be on this special diet, etc.
How do we know it’s not one of these things that is making the difference?
In evidence-based medicine (EBM - not expressed breast milk in this case, ah 🤪), when a study is carried out, all the participants are carefully selected to eliminate bias and confounding factors. For example, anyone who has specific pre-existing illnesses or who are on certain medications are excluded. Later on during the statistical analysis, corrections are made for age, gender, ethnicity, etc.
In this way, EBM tries as hard as it can to let there be only one variable, which usually is whether a participant has been given the treatment/medication or used the method, or not. Then it looks at the outcomes of having this intervention versus not having this intervention.
One other important thing is power. The higher the number of participants in the study, the more power a study has.
For example, if I were going to do a survey on who thinks Barley is cute, and I survey only 2 people...if they both think he is cute, then I can claim that 100% of survey participants think this rascal is cute.
So you can see how important it is to look at the facts in an unbiased way in order to draw an accurate conclusion.
Anecdotal evidence, then, is not really “evidence” at all.
I grew up running around my grandfather’s TCM shop in Tiong Bahru. I can tell you what food is “heaty” and what is “cooling”, just like I’m sure many of your mothers and grandmothers have told you, if you’re Chinese.
Father Choong is even better. He can walk into the house, and from the smell of the brew bubbling on the stove, know what it is, what it’s for, and by extension, which of his siblings my grandfather was boiling it for.
But we can’t tell you why it works, or how it works, other than a rudimentary explanation of it being “replenishing for the liver” or “calming for the uterus”, which is not really an explanation at all.
I don’t even know how “heatiness” can be explained. What is it? How do you measure it? How do you decide what foods are “heaty” and what foods are “cooling”? Why does being “heaty” make you sick? It all seems so arbitrary, with no logic behind it.
And yet, there’s a huge TCM following, despite these questions and no one having answers to them. Do we take it that it’s too complex for us to understand, so we just accept it as the truth that our mothers and grandmothers have spoken? Is it so ingrained in us that we shouldn’t eat chocolate/orange/chicken/cold foods when we are coughing that we truly believe it, even though there’s completely zero evidence for that?
Why don’t we question it? Why do we believe it?
Coming back to my story about the maternal child health nurse (MHCN) asking me to go to the chiropractor...I was completely flabbergasted. Here was a health professional, a nurse who is trained in EBM, advising me to seek out CAM. This would not be as horrifying if there simply was no proven benefit in CAM, if it was just an alternative to see if it works, if it was a “no harm trying” process.
But the thing is: we simply don’t know. So few studies, no evidence, remember? All we have is anecdotal evidence that it works, and case reports of it causing grievous harm. I had a patient who went for a “spinal manipulation”, and who ended up having his vertebral artery dissected, resulting in a stroke at the age of 18. Just this year in February, a Melbourne chiropractor was banned from treating any children after a disturbing video of him manipulating a 2-week old baby was posted.
What makes me really livid are the bold claims that CAM makes. The way it preys on vulnerable people and sells hope to them. Put these drops in water and your cancer will be gone. Take this and you’ll fall pregnant within 2 months. Have your baby’s spine manipulated and her tongue tie will improve.
What the actual f***?! How can you claim this? It’s not even biologically plausible? How does it work? Where is your research? WHERE IS YOUR EVIDENCE?!
And it’s not just that there is no evidence for benefit...there might actually be quite a bit of harm done as well. And CAM practitioners do not tend to inform people of this.
Did you know, for example, that some TCM treatments can cause deranged liver enzymes, and to its worst extent, liver failure? My first death as a doctor occurred because of a case of TCM gone wrong.
The patient had gone for a “washing of cells” treatment, and whatever they had given him had severely injured his liver. For days we kept asking him what he was taking and for days he denied taking any sort of medication at all. The day before he passed, he finally admitted to having taken this thing, but by then it was too late and we couldn’t save him.
It can be really dangerous not to know how something works.
Having said that, I need to also say that western medicine is far from perfect. There are a lot, a lot of things we still don’t know. Like how paracetamol works, for example. But western medicine, I believe, is the best we have, because it constantly searches itself methodically, with the aim of safety and improvement, which I cannot say is the same for CAM.
I recently discovered that many TCM prescriptions contain a form of steroid in them. Of course taking it will make you feel better, then; steroids in the short-term is great! It feels amazing! You can do anything! Then as soon as you stop taking it, you feel crap again...so you reason to yourself that the medicine you were given indeed was effective.
So you go back for more, and more, and meanwhile your bones are becoming more and more osteoporotic from all that prednisolone floating about your system.
Who knows what other side or long-term effects CAM cause, either? My grandfather never told his customers about negative side effects or potential interactions of the prescriptions with other medications...mainly because these are just not known.
Everyone has the right to autonomy in their health care, and in making that decision of risk versus benefit. But how can someone make an informed decision if they can be given neither risks nor benefits based on evidence?
I have much more often heard of all the benefits that CAM claims to offer...and much less often heard of the risks it has.
Mum used to go to a chiropractor (who had the audacity to call himself doctor, as if he went to medical school...misleading the public) until I begged her to stop. He used to claim that he could heal her this and that with his manipulations, but I never heard of him warning her that he might give her nerve damage or a stroke. It was just utter arrogance and it makes me so angry to this day.
And this is why I was so angry with that MCHN for telling her patients to see a chiropractor. She made it seem as if a chiropractor is part of EBM. She made it seem like it would help, even though there is no evidence that it does. And she, being part of EBM herself would be believed by the layperson. Had I not known differently, I really might have taken M to see one and not know of the potential risks involved.
Well, I could go on forever, actually.
I’d like to make some final summary points:
1. CAM is not a “bad” thing.
- We don’t know enough about it to really know what it is, yet.
- However, a lot of it seems biologically implausible (e.g. how does manipulating my spine have anything to do with a thin membrane under my tongue?).
- It has also caused harm.
- But there is also some limited evidence showing that a few TCM treatments do work (and I believe they do, because herbs do have powerful properties; aspirin is, after all, derived from the bark of the willow tree).
2. Preying on vulnerable people to sell them hope is deplorable
- CAM seems to do this a lot, though western medicine is not free from this either
- In any case it is disgusting for anyone to take advantage of people: parents trying their best for their children, loved ones worried about their family members, couples trying to fall pregnant, people with a terminal diagnosis...and sell them hope with baseless claims
3. Use your discernment
- Whether it is western medicine or CAM, always ask the questions: Is this plausible? How would this work? Does it make sense?
- If it sounds too good to be true, it probably is. There is unfortunately no miracle cure for anything. Anyone who tells you otherwise is no better than the quack of old peddling his snake oil (also no evidence, hahaha)
- ⭐️**There is ALWAYS a risk with any intervention; you need to know this to make an informed decision.**⭐️
4. Tradition is a beautiful thing
- As a Chinese person, I treasure my roots and traditions!
- If it clearly does no harm, it’s fine to do it (e.g. I did not eat watermelon during confinement because my grandmother worried that it would “make my legs soft”)!
- However, it’s important to see it for what it is - a beautiful part of culture, rather than an absolute truth...what happens to all the non-Chinese people who don’t practice confinement, then? More than half the world, all get arthritis?
5. Make an informed decision
- I think it’s crucial to realize all these things about CAM first before simply buying into it blindly - to know that there is very little evidence behind it, and that there is the potential to cause much harm.
- If, after all of this, you still choose CAM over western medicine, or both, that is your decision that should be respected
- However, I personally find it very hard not to be disdainful of CAM due to the lack of evidence and all the harm it’s caused!
Thursday, 11 Apr 2019
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