Wednesday, September 15, 2010

Non-evidence based conventional medicine, woo, and Donald Berwick

If you have any interest on this topic, which I covered in a post on Friday, by all means read the comment thread, which is more interesting than the post itself.

It all started with
Kimball Atwood's Health Care Renewal post criticizing the infiltration of woo into purportedly scientific mainstream institutions (like the Institute of Medicine) and its promotion by thought leaders, particularly CMS chief Donald Berwick.

Shannon Brownlee posted a
critical response. At the risk of oversimplification, her point was that it was silly to fret over harmless alternative medicine when there's plenty of conventional medicine (note her inappropriate use of the anachronistic and derisive term “allopathic”) that's not based on best evidence. It was a red herring, beside the point of Atwood's post, but I got sucked into a long back-and-forth anyway, about what's wrong with conventional medicine and why. Although some of her examples of unscientific conventional medicine were factually incorrect (I was able to think of better examples than she was!) we were able to agree that a significant problem exists. I have blogged critically many times about poor adherence to evidence in the house of conventional medicine. It's a complex, multidimensional problem. It has no easy fix. Woo, on the other hand, has an easy fix: we can just say no to nutty ideas. That need not distract in any way from the tougher, more complex problems of inappropriate care in conventional medicine.


Shannon Bronwlee said...

quick question: What is the accepted term for allopathic/conventional/non-alternative medicine?

Sorry I couldn't continue the thread of the original blog. It was very interesting.

R. W. Donnell said...

Thanks for the question. The best term is just "conventional medicine." We often use the term "mainstream medicine." However I find the latter term less useful because "mainstream" institutions (journals, IOM, hospitals, academic medical centers) are now increasingly embracing quackery, for which reason I coined the term "quackademic medicine" a year or so ago.

A word or two about "allopathic." This term was coined in the early days of homeopathy. It is an anachronism and has no relevance today. As I understand it, it was meant to denote the other side of the spectrum from homeopathy. Non-homeopathic treatments in those days would be considered crude and barbaric by today's standards. So if homeopathy was based on the "law of similars" allopathy was said to be based on the "law of opposites." The corollary to this was that allopathy, since it aimed to "oppose" the patient's symptoms, did merely that: masking the symptoms. In contrast, homeopathy, in some mystical way, was supposed to address not the symptoms (how could it, the reasoning went, if the treatment was capable of mimicking the symptoms?) but the actual root cause. It's utter nonsense, of course. At least that's my understanding. Hope it helps.