What does one expect from "conventional" medicine

[mr friendly guy]

In various threads in SLAM about alternative medicines, people have mentioned that there are some negative attitudes in regards the behaviour of practitioners of "conventional" medicine, which has led to some people trying out alternative treatments.

I am interested in what one expects practitioners of conventional medicines should behave.

As someone who works in the public hospital I can contribute some observations I have noticed, some of which I think isn't exactly reasonable.

1. Expect to be treated like a private patient when they come in as a public patient.

In Australia we have a dual private / public hospital system. My views on this are known from previous threads, however to reiterate, I see the private system as taking some of the load of a stretched public system (which caters to most patients).

Private patients do get some benefit which aren't available to public (however this does not relate to the quality of care, despite perceptions). If you need some tests or an operation, you will be placed in line depending on urgency. If you aren't urgent and you want that MRI scan because you are a budding sportsman and you want to get back playing as soon as possible, then you can get it faster as a private patient, if you pay for it. Public hospitals are quite happy to take a patient in as a private one because Private health insurance pays for the stay and it saves the hospital money.

Another benefit of the private patients is the ability to choose their own doctor, and this is where my rant starts. For example, say if you are a conservative Muslim woman and you want a female gynaecologist, you won't necessarily get her. You get which ever doctor is available, regardless of gender. If you want the privilege of having a female doctor, go private and pay for it.

What gets me is patients who come into a public hospital expecting to be able to see a particular doctor (usually the consultant level specialists - ie those who are the highest in their specialty). For those who aren't familiar with medical hierarchy, we have the consultants and several more junior doctors under them (some of these have years of experience and may be very well in the training program for this particular specialty). If there is any problem a doctor can't deal with , it is expected he/she will go the next doctor up in the team, and if they can't deal with it they will call the consultant even waking him/her up in the night if there is a problem.

This bugs me to no end in outpatient clinics when a patient says "Oh, I thought I was expecting to see / I want to see <insert Doctor's name here>. I have to explain that there are so many patients that need seeing, that the doctor they want cannot possibly see every one of them, so there are other doctors to help him take the load. If there is anything I am not quite sure what to do I ALWAYS consult the boss. And lets not get into how the junior doctors are going to get experience if they don't see patients.

If I only I could just tell people if this privilege means so much to you why don't you pay for it as a private patient.


2. Expecting a certain doctor to do a procedure for them

This isn't so much of a problem in surgery, where the surgeons in training do perform certain operations, with the consultants either supervising or coming in if there is a complication. However I did have this problem this week for a diagnostic procedure.

A patient was admitted under one of my consultants for 2 diagnostic procedures (a gastroscopy plus colonoscopy), the latter which requires bowel prep (to clear out the bowels). Now sometimes patients don't do this at home very well (for example they can't tolerate the prep), so occasionally we admit them 1-2 days prior to administer the medications ourselves.

A bit of background, we had to organise transport to the hospital because she herself could not do it. Once admitted she wanted to know if the Doctor she saw in the clinic (my consultant) would be performing the procedure. I didn't know because several doctors performs scoping procedures on different days (there are several gastroenterologists as well as surgeons performing scopes), and while we do try and get you in on the booking doctor's scopes list, it doesn't always happen. And in this case it turned out it was on a different doctor's list. She promptly discharged herself the next day.


That is a fucking waste of time, money and a waste of a hospital bed. The reason she seemed to give was that she wants to meet the Doctor (beforehand) who is going to do the procedure. My question, why? Do you think you can tell a doctor's competence because you met him. Because if not a question of competence, I can't see why this would matter. She even felt I was arrogant merely for explaining the difference between how public and private system works ( and I gave no indication which system I prefered).
The only consolation was that we managed to book someone else in the scopes list.


3. Expectations that you tell them something is wrong (or something serious is wrong) even when there isn't.

I suspect this is a contentious issue here. I have had someone's husband say straight out to me that I don't want you to tell me "its all in her head". I placated him by simplying pointing out that even if that was so, it is still a problem that needed to be dealt with. If its "all in her head" it just means we manage her differently than with an "organic" cause (and I use the word organic very loosely here, and not in the scientific sense). He actually accepted this very well.

I have a few other cases where people wanted to be hospitalised when they didn't warrant it. You would think they would be relieved when you say there isn't something seriously wrong.

I will highlight two cases to illustrate this point

Case one

Patient : I fell, and I have pain on the side / back of my left hip

After questioning the patient says he fell forward and landed forward

Me : If you fell forward, how did you get pain in your side.

patient : I was on a ladder and the ladder fell on top

Me : Ok, I can buy that.

Patient : I think I broken my hip or something

Me : Unlikely because if you did that your leg would be shorten and rotated. But I will x-ray in case the fracture isn't obvious.

After reviewing x-ray


Me : Nope, no fracture.

Patient : But it hurts.

Me : Yes it does. You fell. You bruised the leg but there are no broken bones.

Patient : But shouldn't I stay in, what happens if I get a fever.

Me : why do you think you will get a fever when all you did was fall.

By this point WTF alarm bells were ringing in my head. When he tried to get up, he physically leaped back into bed after rising. It wasn't a case of him not rising up further, he actually leaped back in, ergo he couldn't be that impaired. In the end the physiotherapist came to help him mobilise and was unsuccessful. Another overnight admission in our overfilling emergency department.

Case two

A woman with severe anxiety attacks comes to the emergency department. Her regular private psychiatrist was on holiday apparently. She has had these episodes before and it feels like it.

After making sure that her tremor and chest pain wasn't due to some infection or cardiac cause I was reasonably happy it was just the anxiety. The psychiatric department here wasn't willing to admit someone just because of anxiety, as they pointed out to me, if we did that we would admit you when you are doing exams. They had a point. The psychs did suggest we could try adding for the short term some other meds to control the anxiety.

I pretty much said to her this is clearly a problem but its not something that we need to admit because for one the hospital isn't going to be able to do anything more than what the psychiatrist had already advise me to do.

Her : But I can't walk (because of the tremor)

Me : But you just walked a few minutes ago to the toilet. I saw you walking.

Her : Well now I can't.

At this point I could see which way the wind is blowing. I ask the ED consultant how should we proceed here and he showed me a neat little trick. When you distract the patient, the shaking actually stops. Unfortunately you can't do this forever and if she "can't" stand, then we have no choice but to admit much to the consultant's disgust.

Fortunately the medical registrar refused to admit her (and I agree) when I said this is likely just anxiety. There is nothing to suggest an "organic" cause unless you want to do more extensive investigations looking for one. He declined. He told me what to tell the patient, which was essentially a regurgitation of what I said earlier. In the end I managed to get her to walk out despite her protestations that she couldn't and we apparently don't care about her.

4. High praises for alternative medications but ultimately rock up to a public hospital which practices conventional medicine.

That pretty much says it all really. Natural medications might be able to cure cancer and treat your arthritis (sarcasm) but when you cut yourself or break bones you need stitches and plaster. When you have a bowel obstruction or a large abscess, taking herbs isn't going to make it go away. You need a surgeon.

Of course even after you stitch them up and offer them a tetanus ivaccination because they had a laceration they refuse because "my mother doesn't believe in vaccinations".

So any thoughts on the OP.

[Darth Wong]

There are plenty of obnoxious idiots who use alternative-health remedies, but at the same time, there are legitimate reasons for people to lose faith in conventional medicine. The biggest one is related to the big pharmaceutical companies. Things like antidepressants for example, or expensive brand-name drugs that do the same thing as a much cheaper, older drug that has passed out of patent protection and is now available in generic form, but which are still prescribed by certain doctors for reasons unknown to anyone but the doctor and the pharmaceutical company which sent him on an all-expensed-paid trip to Hawaii to attend one of their seminars.

It's a lot like auto mechanics. There seem to be enough lazy or crooked ones out there to give the industry a black eye, and the industry isn't really doing enough to clamp down on that kind of behaviour.

There's also the desperation factor. When you're told that the doctors really can't do anything for you, you might as well try alternatives. A good example is Chronic Fatigue Syndrome. What do the doctors say when you have it? Well, we don't know what causes it, and there's really nothing you can do but take it easy. For the next fucking year. At least.

[Lagmonster]

Ignorance plays a part in people's attitudes. People watch 'ultra-realistic' medical dramas on TV and assume that doctors only have to get together for ten minutes and will suffer a stroke of genius in which they know precisely what's wrong with you and how to fix it, all in under one hour.

As well, I might add that people don't generally act gracious when they think they're hurt. They get selfish and panic easily. It's also possible that many people don't have anyone at home competent or willing to take care of them, and so they feel better when they wrap themselves in the blanket of a science that's 'supposed to know what it's doing'. It's like religious people who go to church mainly because they want to find someone who will take away their guilt over having premarital sex - when in doubt, throw it on the laps of the professionals and don't let go no matter what rational arguments the rest of the world throws at you.

[Spoonist]

One thing the scam artists are good at is attitude and focus. They will beat medical care hands down every time. Because in real life medical care has to be effecient as well as competent.
This leaves lots of people with the feeling that they where "not treated" properly, either they didn't get the result they expected or the attention they expected. But the quacks know this and will sit down and give their victims their complete focus, then they will always say that oh it is serious just like you think it is but and here comes the ka-ching part they will try to fix it no matter what. So even if people later admit they didn't get better because of the treatment they will always say that the quack did their best.

Its the same story as with science, we have educated our medical staff to sich a high degree that they know that it is impossible to know everything, so they will tell the patient that it could be this or this or this but maybe it could be something else, then when they find it they tell the patient that they have a treatment that usually works but sometimes goes wrong. This in contrast to the quack who usually very strongly tells you exactly what is wrong (imbalanced fluids) to give the impression of knowledge, then they tell you that they have something that helped this and this person that they hope will work for you as well.

Now some of the smart private clinics have looked at why people go to alternative medicine and then incorporated the approach. Having a nurse/public relations person meat you who will give you their full attention and give you reassurance, while doing the ground work for the doctors who can then sweep in be as cold as they like and do what they do best and then when they are done, then again the nurse/public relations person is the one who relays the information in laymans terms to the patient.
They make a shitload of money from this because people feel cared for while at the same time they receive comptent care.

[Broomstick]

What gets me is patients who come into a public hospital expecting to be able to see a particular doctor (usually the consultant level specialists - ie those who are the highest in their specialty). For those who aren't familiar with medical hierarchy, we have the consultants and several more junior doctors under them (some of these have years of experience and may be very well in the training program for this particular specialty). If there is any problem a doctor can't deal with , it is expected he/she will go the next doctor up in the team, and if they can't deal with it they will call the consultant even waking him/her up in the night if there is a problem.

This bugs me to no end in outpatient clinics when a patient says "Oh, I thought I was expecting to see / I want to see <insert Doctor's name here>. I have to explain that there are so many patients that need seeing, that the doctor they want cannot possibly see every one of them, so there are other doctors to help him take the load. If there is anything I am not quite sure what to do I ALWAYS consult the boss. And lets not get into how the junior doctors are going to get experience if they don't see patients.

If I only I could just tell people if this privilege means so much to you why don't you pay for it as a private patient.

In the US, the top specialists typically can't be seen unless you're referred by another doctor. And even then it might not be easy.

(This is on my mind because my husband has been referred to a specialist as of today - said specialist's office would not accept a hand-written note from our doctor, they want it on letterhead, and they want him to have an MRI workup. Which ain't gonna happen, given the amount of hardware holding hubby's right leg together. A couple of kilos of metal, to be precise, and I do not exaggerate. Getting him into a room with an MRI machine would be no problem, but they'd have to de-activate the magnet to pry his leg off it. Mind you, we've got the best health insurance money can buy, as good as what Congress gets, and we're still dealing with crap - I don't want to think about what Joe Average goes through these days.)

[mr friendly guy]

Things like antidepressants for example, or expensive brand-name drugs that do the same thing as a much cheaper, older drug that has passed out of patent protection and is now available in generic form, but which are still prescribed by certain doctors for reasons unknown to anyone but the doctor and the pharmaceutical company which sent him on an all-expensed-paid trip to Hawaii to attend one of their seminars.

They are still allowed to fly Doctors to expensive locations to attend seminars? I was told that drug companies can no longer do that over here. Of course they do give me some nice stuff, not that I think it particularly effects my prescribing choice since any medications I start is either
a) the generic form
b) the standard treatment
c) what the boss wants.
d) what the drug company is advertising is the only treatment available (with government subsidies - for example with hepatitis C meds).
And the fact that I tend to just take their stuff and run instead of staying to talk tends to decrease chance of indoctrination.

I have noticed GPs do tend to prescribe the non-generics. For example one of the treatments of ulcers is a class of drugs called PPIs. The generic isOmeprazole. But I have seen various others prescribed much more frequently.

In the US, the top specialists typically can't be seen unless you're referred by another doctor. And even then it might not be easy.

Its the same here as well. The rationale is that we need another Doctor to "follow up" the patient, for example if the patient lived in an isolated country town and needed regular blood tests, its more convenient for them if their GP handles it and sends us the results, as opposed to the patient coming into the hospital for the test. The GP should also be informed as they are essentially the first port of call so to speak.

[PainRack]

Well, there's always the issue of pain.

When a person is aching in full blown pain, the only thing on their mind is what the fuck you can give them that will suppress it TOTALLY.

This even though he's already on painkillers like pro-codeine and tromodol and pethidine.

[Mange]

I expect 'conventional' medicine to be scientifically documented, nothing more. Here in Sweden, the Green Party (which the Social Democratic government must rely on together with the Communists), last year referred to 'conventional' medicine in a bill to the Riksdagen (the Swedish parliament) as "consisting of synthetic substances and chemicals which automatically are poisonous for the body". The outcome of that bill was that the Antroposophic Vidar clinic, located in Järna located about 50 km southwest of Stockholm, would recieve 3 million Swedish kronor (~$415,000) per year for three years (in addition to the other monetary support it recieves from the taxpayers pockets).

[Lord Zentei]

From the OP:

1. Expect to be treated like a private patient when they come in as a public patient.

No sympathy as long as there is welfare to fall back on: you get what you pay for.

2. Expecting a certain doctor to do a procedure for them.

I can see how this would be confusing to people if they have been referred to someone specific. They understandibly don't want to end up in the wrong operating room.

3. Expectations that you tell them something is wrong (or something serious is wrong) even when there isn't.

In somce cases, if it took them much time and effort to get where they are, especially if they have been referred there by another doctor (even if they talked him into it), that's not that surprising, More generally, such things are a mite childish: it's like a kid asking for a band aid on its little bruise.

4. High praises for alternative medications but ultimately rock up to a public hospital which practices conventional medicine.

This may be contempt born from familiarity, and hope for "something else" in their dreary little lives. No sympathy. Though sometimes it may be understandible if there is genuinely little no hope for them otherwise or if conventional treatments are beyond their reach for whatever reason.

I expect 'conventional' medicine to be scientifically documented, nothing more. Here in Sweden, the Green Party (which the Social Democratic government must rely on together with the Communists), last year referred to 'conventional' medicine in a bill to the Riksdagen (the Swedish parliament) as "consisting of synthetic substances and chemicals which automatically are poisonous for the body". The outcome of that bill was that the Antroposophic Vidar clinic, located in Järna located about 50 km southwest of Stockholm, would recieve 3 million Swedish kronor (~$415,000) per year for three years (in addition to the other monetary support it recieves from the taxpayers pockets).

Good grief. How are these Green lunatics polling anyhow? Anyway, agreed that scientific documentation is a requirement.

[mr friendly guy]

Well, there's always the issue of pain.

When a person is aching in full blown pain, the only thing on their mind is what the fuck you can give them that will suppress it TOTALLY.

This even though he's already on painkillers like pro-codeine and tromodol and pethidine.

Well there is pain, and then there's PAIN. Some of these people you know they are in pain, they scream and you need morphine and pethidine. Some people you know are in (chronic) pain because they tell you. Instead of screaming, they say ouch, ouch, ouch.

Otherwise you wouldn't know they are in pain because they walk up and about. And did I mention that (for some of them ) their pain seems to disappear when you distract them even though you palpate the same painful area? And another thing, they tend to end up on shit laods of opiod analgesics.

These chronic pain patients are difficult to manage and they usually end up in the chronic pain clinics which are run by anaesthetist. They usually like to give things like gabapentin or amitriptyline (and yes I realise one is an anti seizure medication and the other is an antidepressant), which do seem to have some pain modifying affects.

These people are ones which "conventional" medicine has problems dealing with. I wonder if alternative medicines tell them they will get better, and they so want to believe, they think the pain (which most probably is largely "in their head" to begin with) has gotten better. Its almost like how faith healers convince people.

[Fire Fly]

The number one issue I see with "conventional" medicine is that people demand medicine when they see a doctor. The issue, I see it as, is due to money and a pyschological need to be treated if one is afflicted, however minor. Many people I know who go to their clinics often do not like to pay the US copay of $10, $15, or $20 only to be turned away by a nurse/doctor because it will get better in a few days. My mother is often such a case: whenver she gets a cold, sore throat, or some other respiratory ailment, she makes an appointment so she can get the medicine she wants, not the medicine that is prescribed. Often, she will claim the one prescribed is not as effective as the one she wants.

One of the prime reasons, I believe, why alternative medicine has come into popularity as of late is because people are tired of the bureaucracy of medicine, are not getting the desired results, and the growing cost of medicine is outpacing the financial income of many. A person would rather try some nouveau herb from the shop on the corner to a surgical procedure that could cost tens of thousands of dollars and if they believe hard enough, this nouveau herb will work, or so it would appear to.

On the other hand, while I am not an ardent proponent of herbs and folk medicine, I most certainly believe that there is a degree of validity to a great many of them (not the kind that is adovcated by nouveau medicine shops ran by hippies). There is a substantial volume of scientific literature which has documented folk medicine from around the world (PDFs: 1, 2, 2) and has shown it to be valid. The most prime example is salicylic acid, otherwise known as asprin. However, the issue I see as to why these folk medicine are not displacing many of the current drugs is because the current batch of drugs/medicine are more effective and have been more thouroughly researched.

[Glocksman]

One of the prime reasons, I believe, why alternative medicine has come into popularity as of late is because people are tired of the bureaucracy of medicine, are not getting the desired results, and the growing cost of medicine is outpacing the financial income of many. A person would rather try some nouveau herb from the shop on the corner to a surgical procedure that could cost tens of thousands of dollars and if they believe hard enough, this nouveau herb will work, or so it would appear to.

Even highly educated people fall for some of the more dubious alternative medicine products.
My uncle is a case in point. He is 60 years old, has a BA from Indiana University and an MBA from Cornell, and yet he swears by Penta Water despite it being a scam.

This isn't to say that all alternative/herbal medicines are scams like Penta water (Valerian is one example of a legitimate alternative medicinal herb), but some of the claims made for the more dubious products beggar belief.

[PainRack]

Well there is pain, and then there's PAIN. Some of these people you know they are in pain, they scream and you need morphine and pethidine. Some people you know are in (chronic) pain because they tell you. Instead of screaming, they say ouch, ouch, ouch.

Otherwise you wouldn't know they are in pain because they walk up and about. And did I mention that (for some of them ) their pain seems to disappear when you distract them even though you palpate the same painful area? And another thing, they tend to end up on shit laods of opiod analgesics.

These chronic pain patients are difficult to manage and they usually end up in the chronic pain clinics which are run by anaesthetist. They usually like to give things like gabapentin or amitriptyline (and yes I realise one is an anti seizure medication and the other is an antidepressant), which do seem to have some pain modifying affects.

These people are ones which "conventional" medicine has problems dealing with. I wonder if alternative medicines tell them they will get better, and they so want to believe, they think the pain (which most probably is largely "in their head" to begin with) has gotten better. Its almost like how faith healers convince people.

I seen both types of people in my studies as it is and let's face it, conventional medicine has absolutely nothing in its arsenal to address their concerns. Their concern isn't about how to make pain managable. Its about how to make pain disappear so that it would no longer be an aching, constant scream in their daily lives.

Unfortunately, pain is as much pyschological as it is physical and that's why people who do use alternative therapies, from aromatherapy to "prayer" get relief from pain.

[Broomstick]

I expect 'conventional' medicine to be scientifically documented, nothing more. Here in Sweden, the Green Party (which the Social Democratic government must rely on together with the Communists), last year referred to 'conventional' medicine in a bill to the Riksdagen (the Swedish parliament) as "consisting of synthetic substances and chemicals which automatically are poisonous for the body". The outcome of that bill was that the Antroposophic Vidar clinic, located in Järna located about 50 km southwest of Stockholm, would recieve 3 million Swedish kronor (~$415,000) per year for three years (in addition to the other monetary support it recieves from the taxpayers pockets).

Good grief. How are these Green lunatics polling anyhow? Anyway, agreed that scientific documentation is a requirement.

Then both of you must be sorely disappointed, because something like 70-80% of "conventional medicine" has never been subjected to a scientific evaluation.

[Lord Zentei]

Then both of you must be sorely disappointed, because something like 70-80% of "conventional medicine" has never been subjected to a scientific evaluation.

I knew that the figure was higher than acceptable, but this is a surprise.

[Lord Zentei]

Shoot. GHETTO:

Some? Not that I'm doubting your statement, but I'm rather interested in knowing more about this.

[Broomstick]

Otherwise you wouldn't know they are in pain because they walk up and about. And did I mention that (for some of them ) their pain seems to disappear when you distract them even though you palpate the same painful area? And another thing, they tend to end up on shit laods of opiod analgesics.

These chronic pain patients are difficult to manage and they usually end up in the chronic pain clinics which are run by anaesthetist. They usually like to give things like gabapentin or amitriptyline (and yes I realise one is an anti seizure medication and the other is an antidepressant), which do seem to have some pain modifying affects.

These people are ones which "conventional" medicine has problems dealing with. I wonder if alternative medicines tell them they will get better, and they so want to believe, they think the pain (which most probably is largely "in their head" to begin with) has gotten better. Its almost like how faith healers convince people.

First of all, even in those cases where pain is "in the head", it is still pain. Somaticizing disorders that translate emotional issues into pain or other physical ills aren't imaginary in the sense that they do cause real, physical distress. When they manifest as vomiting or diarrhea ("nervous gut") or rashes or heart palpitations it's hard to dispute their existance, why should we dispute the existance of pain manifestations? (usually, because we can't see pain). Of course, the treatment for such is different than pain for something like a broken leg. These people should not be dismissed as fakers.

Then there are the chronic pain syndromes - acute pain that is untreated or poorly treated can lead to permanent changes in the nerves, leaving them hypersensitive to any stimuli, or even no stimuli. Basically, the pain signal gets switched "on" and then stuck there, even after other physical damage heals. The best way to prevent this is to treat acute pain promptly and completely - but this is not always done because of exaggerated fears of addiction. When it gets to the point of chronic pain it really needs treatment by a specialist in the field, as simply throwing opiates at it is not the best course of action. Research is currently being done on how to reverse these unwanted changes in pain-sensing nerves.

The fact that distracting someone can reduce the perception of pain is not proof that the pain does not exist. No one disputes that getting a needle poked into your arm hurts (even if only a little) and we routinely distract young children getting shots to reduce their perception of that pain. Focusing on pain only makes it worse. It is theorized that hypnosis can act as anesesthia by directing the patient's attention elsewhere so firmly that the concious mind does not pay attention to the pain signals. Learning to use this technique of distraction is actually a valuable tool in treating chronic pain. It doesn't make the pain go away, but it can minimize the impact it has on a person's ability to function.

[mr friendly guy]

First of all, even in those cases where pain is "in the head", it is still pain.

I am aware of that. I even mentioned something to that effect in my OP.

Somaticizing disorders that translate emotional issues into pain or other physical ills aren't imaginary in the sense that they do cause real, physical distress.

However somatising disorders are something that is best dealt with by psychiatrists rather than say physicians or doctors in the Emergency department. The problem is a lot of these people want a physical cause of their ailment which is independent of "all in the head". I suspect this is of the same type of social stigma attached to mental illnesses, that they aren't a "real" disease, and more a weakness of character.

When they manifest as vomiting or diarrhea ("nervous gut") or rashes or heart palpitations it's hard to dispute their existance, why should we dispute the existance of pain manifestations? (usually, because we can't see pain). Of course, the treatment for such is different than pain for something like a broken leg. These people should not be dismissed as fakers.

I do try to distinguish between somatisation and malingering (which is faking it for some sort gain). Unfortunately it is difficulty, and sometimes there are obvious gains for them (say a workers compensation claim) or less blatant (but you can't help it wondering), say a patient adopting the "sick role".

Then there are the chronic pain syndromes - acute pain that is untreated or poorly treated can lead to permanent changes in the nerves, leaving them hypersensitive to any stimuli, or even no stimuli. Basically, the pain signal gets switched "on" and then stuck there, even after other physical damage heals. The best way to prevent this is to treat acute pain promptly and completely - but this is not always done because of exaggerated fears of addiction. When it gets to the point of chronic pain it really needs treatment by a specialist in the field, as simply throwing opiates at it is not the best course of action. Research is currently being done on how to reverse these unwanted changes in pain-sensing nerves.

I have noticed that chronic pain specialists love giving gabapentin. Another one doctors like to give after the opiod option has been exhausted is tricyclic antidepressants such as amitriptyline.

The fact that distracting someone can reduce the perception of pain is not proof that the pain does not exist.

No. But I do question the severity of the pain if it can be totally reduced by distraction. I do question the need of continuing to give these people high levels of opiods.

[Darth Wong]

In the end, however, as I said earlier, much of the blame for loss of faith in conventional medicine has to fall upon conventional medicine itself. Too many snake-oil products are given FDA approval and sold over pharmacists' counters to expect people to have the kind of complete faith in the system that you want them to have. The pharmaceutical companies and a community of doctors who simply believe in the efficacy of certain therapies or drugs even without independent results-based analysis have combined to create this cynicism.

People are more cynical about conventional medicine today than they were 30 years ago. One might argue that this is due to some sort of brilliant marketing by the alternative-health people, but how much marketing do they actually produce, compared to the deluge of marketing from Big Pharma? I'd say that a constant stream of news stories about bullshit being sold by Big Pharma has been far more corrosive to consumer trust than anything that alternative-health practitioners or merchants could possibly say with their relatively meagre resources.

[Broomstick]

First of all, even in those cases where pain is "in the head", it is still pain.

I am aware of that. I even mentioned something to that effect in my OP.

Consider my statement to be underlining yours, then.

Somaticizing disorders that translate emotional issues into pain or other physical ills aren't imaginary in the sense that they do cause real, physical distress.

However somatising disorders are something that is best dealt with by psychiatrists rather than say physicians

In the US you can not call yourself a psychiatrist without an MD. Therefore, here all psychiatrists are physicians. Those who are doctorate level but do not have MD's are psychologists.

There is a doctor - MD - on the east coast who is not a psychiatrist, but who has a speciality in treating back pain of mental/emotional origin. He started as a traditional orthopedic surgeon speacializing in the back, and became discouraged at how seldom traditional surgery and therapy actually worked. However, he emphasizes very strongly that you must do a thorough work up to eliminate and/or treat all possible organic origins of the pain before proceeding to the "emotional origin" diagnosis. He has had some very good successes, but no one is interested in funding an exhaustive study of either the screening process or the treatment he proposes. It is controversial because it messes with the focus on mechanics and physical origin for disease/syndromes. And finally, there's the whole issue of mental illness and stigma - but this isn't a mental illness in the way people ordinarially think of such. While people are willing to believe that emotions and stress can affect the heart and blood pressure they seem much more reluctant to entertain the idea that it can manifest in physical symptoms in the back or in pain syndromes involving the muscles.

In this case, the treatment is "alternative" in that it is not the standard treatment, but it's still conventional medicine in that the doctor uses objective criteria in the screening process (only a subset of possible patients receive a positive diagnosis) and his treatment regimine is basic in priciples rooted in conventional medical science. Nor does he suggest this is an instant cure - usually take 18 months to 2 years to complete the process - and he doesn't promise a complete cure in all cases. He admits there are some people unsuitable for this treatment or who do not respond. This is an interesting case of a new approach to an old problem, in contrast to "new-age" bullshit snake oil.

The problem is a lot of these people want a physical cause of their ailment which is independent of "all in the head". I suspect this is of the same type of social stigma attached to mental illnesses, that they aren't a "real" disease, and more a weakness of character.

Right, and that's why I emphasize that this is REAL pain, real problems, not imagined. Just as a fever has many potential causes, so does pain. You don't treat elevate temperature from excerising on a hot day as you would a malarial fever, but they're both real fevers in the sense of body temperature being higher than normal. Likewise, you treat pain from a mental/emotional/stress origin differently than pain from an acute injury or a disease process, but they're both real pain.

I do try to distinguish between somatisation and malingering (which is faking it for some sort gain). Unfortunately it is difficulty, and sometimes there are obvious gains for them (say a workers compensation claim) or less blatant (but you can't help it wondering), say a patient adopting the "sick role".

There is no disputing that making these calls can be difficult.

Then there are the chronic pain syndromes - acute pain that is untreated or poorly treated can lead to permanent changes in the nerves, leaving them hypersensitive to any stimuli, or even no stimuli. Basically, the pain signal gets switched "on" and then stuck there, even after other physical damage heals. The best way to prevent this is to treat acute pain promptly and completely - but this is not always done because of exaggerated fears of addiction. When it gets to the point of chronic pain it really needs treatment by a specialist in the field, as simply throwing opiates at it is not the best course of action. Research is currently being done on how to reverse these unwanted changes in pain-sensing nerves.

I have noticed that chronic pain specialists love giving gabapentin. Another one doctors like to give after the opiod option has been exhausted is tricyclic antidepressants such as amitriptyline.

The pain docs in this country are moving to anti-depressants (several cateogries) and anti-seizure medications much sooner than they used to. Partly, it's a recognition that chronic pain can make you depressed - of course it can, if you're hurting all the time you're unhappy - but also because they seem to moderate some of the changes caused by chronic pain, desensitizing the hyperactive pain mechanism.

The fact that distracting someone can reduce the perception of pain is not proof that the pain does not exist.

No. But I do question the severity of the pain if it can be totally reduced by distraction. I do question the need of continuing to give these people high levels of opiods.

There's a difference between pain being reduced/elminated and learning to function despite pain. Which is where the problem of diagnosis comes in - if someone is claiming intense leg pain, yet can walk without problem are they malingering, faking, or able to function despite pain?

Which is another reason some of the snake oil holds such appeal - the salesmen are so certain, so earnest... so much more inspiring of faith than an MD who is being honest and saying "Hmm... I'm not sure where the pain is coming from, we have to look at this problem from several angles"

[Illuminatus Primus]

There are plenty of obnoxious idiots who use alternative-health remedies, but at the same time, there are legitimate reasons for people to lose faith in conventional medicine. The biggest one is related to the big pharmaceutical companies. Things like antidepressants for example, or expensive brand-name drugs that do the same thing as a much cheaper, older drug that has passed out of patent protection and is now available in generic form, but which are still prescribed by certain doctors for reasons unknown to anyone but the doctor and the pharmaceutical company which sent him on an all-expensed-paid trip to Hawaii to attend one of their seminars.

It's a lot like auto mechanics. There seem to be enough lazy or crooked ones out there to give the industry a black eye, and the industry isn't really doing enough to clamp down on that kind of behaviour.

There's also the desperation factor. When you're told that the doctors really can't do anything for you, you might as well try alternatives. A good example is Chronic Fatigue Syndrome. What do the doctors say when you have it? Well, we don't know what causes it, and there's really nothing you can do but take it easy. For the next fucking year. At least.

You'd be surprised how many people even screw themselves by demanding brand-names, just like in every other product.

[Illuminatus Primus]

In the end, however, as I said earlier, much of the blame for loss of faith in conventional medicine has to fall upon conventional medicine itself. Too many snake-oil products are given FDA approval and sold over pharmacists' counters to expect people to have the kind of complete faith in the system that you want them to have. The pharmaceutical companies and a community of doctors who simply believe in the efficacy of certain therapies or drugs even without independent results-based analysis have combined to create this cynicism.

People are more cynical about conventional medicine today than they were 30 years ago. One might argue that this is due to some sort of brilliant marketing by the alternative-health people, but how much marketing do they actually produce, compared to the deluge of marketing from Big Pharma? I'd say that a constant stream of news stories about bullshit being sold by Big Pharma has been far more corrosive to consumer trust than anything that alternative-health practitioners or merchants could possibly say with their relatively meagre resources.

So what is the solution? How do you tighten scientifically the medical community and to strongarm Big Pharma into place? Personally, I think some trust-busting could help. More legitimate competition on many levels, price, research, etc. and more controls on exorbant marketing would help.

But I don't know how to deal with a lot of the issues surrounding the cost of these medical studies and proving the efficiacy of drugs. Healthcare economics has been going to work on a lot of "traditions" doctors conform to which are actually not born out of statistical analysis and to get at cutting them out, but what else can be done?

[Darth Wong]

So what is the solution? How do you tighten scientifically the medical community and to strongarm Big Pharma into place? Personally, I think some trust-busting could help. More legitimate competition on many levels, price, research, etc. and more controls on exorbant marketing would help.

The government should also conduct a lot of its own research. I fail to see the logic of granting billions on research-related tax breaks and grants to Big Pharma instead of simply using the money to fund independent research, except that people would call it "socialist" which would instantly mean it must be wrong. There should be a separate watchdog bureau conducting these tests, apart from the FDA whose own chairman has admitted before Congress that it tends to put industry interests ahead of public safety.

But I don't know how to deal with a lot of the issues surrounding the cost of these medical studies and proving the efficiacy of drugs. Healthcare economics has been going to work on a lot of "traditions" doctors conform to which are actually not born out of statistical analysis and to get at cutting them out, but what else can be done?

More of these watchdog organizations would help. Some of them already exist, but why not take some of the billions we're handing out to Big Pharma and keep them so the government can conduct some of this oversight?

The huge amount of government money flowing to fund Big Pharma's research activities is one of those little-known aspects of the system. Something like a third of medical research in the US is government-funded, but private organizations still somehow end up walking away with all of the patents.

[Illuminatus Primus]

Yeah, either get your hands out of the dole or submit to more oversight and controls. That's total bullshit and corporate welfare.

I think that'd be a great idea for an agency and have public support. Lobbyists would screech though.

[Mange]

I expect 'conventional' medicine to be scientifically documented, nothing more. Here in Sweden, the Green Party (which the Social Democratic government must rely on together with the Communists), last year referred to 'conventional' medicine in a bill to the Riksdagen (the Swedish parliament) as "consisting of synthetic substances and chemicals which automatically are poisonous for the body". The outcome of that bill was that the Antroposophic Vidar clinic, located in Järna located about 50 km southwest of Stockholm, would recieve 3 million Swedish kronor (~$415,000) per year for three years (in addition to the other monetary support it recieves from the taxpayers pockets).

Good grief. How are these Green lunatics polling anyhow? Anyway, agreed that scientific documentation is a requirement.

Then both of you must be sorely disappointed, because something like 70-80% of "conventional medicine" has never been subjected to a scientific evaluation.

I don't know how things are in the U.S., but here in Sweden, every 'conventional' medicine must, in order to be approved be scientifically tested by the Swedish Medical Products Agency. The agency establishes how the medicine works, it's composition, how effective it is, what side effects it has and if it's of good quality. However, nowadays it's the European Union which centrally approves most medicines and its committees are using very much the same criterias. So, there are very high standards for the evaluation of "conventional medicine" here.