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Allopathic Usurpation of Natural Medicine: The Blind Leading the Sighted

By Alex Vasquez, DC, ND, Editor, Naturopathy Digest

Why are medical doctors, rather than naturopathic doctors, considered the "experts" in natural medicine? I can't help but notice a scientifically inexplicable phenomenon that has repeated itself again and again for the past several decades in various ways.

I think you'll agree that it does not make sense, and I'll present my observations and the data in the paragraphs that follow.

When I read the mastheads of most "alternative medicine" journals, nearly all of the editors and reviewers are allopathic medical doctors (MDs). Only rarely will there be a token DC, ND or DO on the list. When I read the list of keynote speakers at major national seminars and conventions on "complementary medicine," the keynote speaker generally is an MD. Rarely is there a PhD, and almost never is there a DC, ND or DO.

Take a look at the leadership of the NIH's National Center for Complementary and Alternative Medicine; theoretically, these are the people overseeing research and the so-called "integration of CAM therapies into conventional medical practice." Of the degrees listed at the nccam.nih.gov Web site as of November 2005, I note seven MDs, six PhDs, and one MPH (Master of Public Health). Among the leadership, there are no DCs, NDs or DOs.

Strangely, even among the so-called "national and international experts in alternative and complementary medicine," most of the names and faces are those of MDs. It's somehow as if anyone with an MD degree who can pronounce the word "vitamin" and who touts the merits of yoga and mint tea is whisked up the escalator of fame and acclaim. When most of these self-proclaimed experts talk and write books on "CAM" and "natural medicine," I find their material to be simplistic babble that does not surpass what I could hear from any second- or third-year naturopathic medical student. I think it's a disgrace to natural medicine and a disservice to the general public that these pseudo-experts are allowed to misrepresent the merits and clinical applications of natural medicine, when most of them have never had a graduate-level class in nutrition, let alone botanical medicine, let alone environmental medicine. How can it be that MDs are assumed to be the experts in everything, even on topics for which they have received no training, such as diet, exercise and spinal manipulation? It must be that they receive an excellent education on the "clinically important" topics. It must be that their clinical practices are models of efficiency and effectiveness. It must be that the scientific method upon which their therapies and training is founded endows them with penetrating insight into all matters clinical. Those must be the reasons, right? Let's take a look at the research.

The Myth of Excellence in "Medical" Education and Training

Several recent articles in allopathic journals have examined the quality of current medical education, which descended directly from past medical education; therefore, we can assume that its present state is representative of the past from which it sprang. A review article on the quality of medical education published last year in the Journal of the American Medical Association (JAMA) stated, "Medical education is failing to prepare students adequately for their future practice."1 A different article in that same issue portrayed the situation more graphically; the editor of the journal wrote that medical education "is currently being held together by peanut butter and bubble gum."2

Since I have a particular interest in naturopathic orthopedics,3 and since a large percentage of clinical visits center on the diagnosis and management of musculoskeletal pain, I wanted to see how MDs perform when it specifically comes to musculoskeletal diagnosis and assessment. Unfortunately, the results here are no better than the aforementioned combination of peanut butter and bubble gum. Allopathic medical education recently was described as "woefully inadequate" in preparing medical doctors for the diagnosis and treatment of musculoskeletal conditions, and some medical doctors graduate and are licensed without any training in orthopedics whatsoever.4

In their 2004 review published in Physician and Sportsmedicine, Joy and Van Hala describe the formal training of a sample of 85 recent medical graduates: "(T)he average time spent in rotations or courses devoted to orthopedics during medical school was only 2.1 weeks. One third of these examinees graduated without any formal training in orthopedics. As would be expected, these data suggest that limited educational experience contributes to poor performance."

In 1998, Freedman and Bernstein5 published a landmark study in the Journal of Bone and Joint Surgery wherein they administered a validated musculoskeletal competency examination to 85 recent medical graduates who had begun their hospital residencies. Eighty-two percent of these medical doctors failed to demonstrate basic competency on the examination, leading the authors to conclude, "We therefore believe that medical school preparation in musculoskeletal medicine is inadequate." They repeated their study in 2002, and again found widespread incompetence and concluded that "medical school preparation in musculoskeletal medicine is inadequate."6

In February 2005, Matzkin, et al.,7 administered a standardized musculoskeletal test to 334 medical students, residents and staff physicians. The conclusion from their study reads as follows, "Seventy-nine percent of the participants failed the basic musculoskeletal cognitive examination. This suggests that training in musculoskeletal medicine is inadequate in both medical school and nonorthopaedic residency training programs."

In August 2005, Schmale,8 from the University of Washington, showed that when a standardized musculoskeletal examination was administered, "less than 50% of fourth-year students showed competency. These results suggested that the curricular approach toward teaching musculoskeletal medicine at this medical school was insufficient." These results are particularly alarming because the University of Washington is ranked consistently as the best medical school in America;9 if more than 50 percent of graduates from the best medical school in the country are orthopedically incompetent, what does that suggest about the physician graduates from the other schools? If medical schools across the nation are failing to prepare doctors to evaluate and thus treat patients with musculoskeletal complaints, would this not present a danger to the health of patients seeking care? What might be the consequences of such widespread professional ineptness? How is it that these same MD graduates go on to dominate health care practice, research and policy in this country?

The Myth of the Superiority of "Medical" Efficiency and Safety

Let's examine the overall cost-effectiveness of American medicine. The rhetoric that American medicine is a model of efficiency and effectiveness simply does not stand when confronted with hard data. In 2000, the director of the World Health Organization's Global Program on Evidence for Health Policy, Christopher Murray, MD, PhD,10 concluded, "Basically, you die earlier and spend more time disabled if you're an American rather than a member of most other advanced countries." According to the 1999 review by Anderson and Poullier,11 the average annual income for allopathic medical physicians in America (approximately $200,000 per year) is disproportionately higher than the income for physicians in other countries (approximately $100,000 per year), especially considering the superior health outcomes commonplace in other nations that spend much less per capita. Exorbitant medical expenses impoverish American families12 and cripple American businesses.13

Now let's look at the issue of health care safety. The data shows that Americans suffer an astoundingly high level of iatrogenic (doctor-induced) morbidity and mortality in the process of receiving medical care. Indeed, drug interactions, drug "side-effects," prescription errors, unnecessary surgeries and "hospital errors" are a leading cause of death in America. The number of deaths due to "medication errors" more than doubled from 1983 to 1993,14 and this might have been due to the spreading of so-called "managed care," which results in doctors having less time with patients and therefore having to make more quick decisions - decisions that are increasingly erroneous.

Lazarou, et al.,15 published a landmark report in JAMA in 1998, showing that hospital-supervised administration of drugs leads to adverse effects in more than 2.2 million American patients and directly results in more than 100,000 deaths, thus "making these reactions between the fourth and sixth leading cause of death." An article by Starfield,16 published in JAMA in 2000, documented that allopathic medicine is the third leading cause of death in America, after heart disease and cancer. This article can be paraphrased as stating that "iatrogenic causes" result in "225,000 deaths per year," constituting "the third leading cause of death in the United States." Other estimates have been more conservative, such as the 1997 review by Holland and Degury17 in American Family Physician, wherein the authors note, "Recent estimates suggest that each year more than 1 million patients are injured while in the hospital and approximately 180,000 die because of these injuries. Furthermore, drug-related morbidity and mortality are common and are estimated to cost more than $136 billion a year."

Thus, according to these authoritative reviews, we reasonably can conclude that not fewer than 110,000 and up to 225,000 American patients are killed every year by adverse drug effects, hospital errors, and other "side-effects" of allopathic medicine. Placing this into a public health context, we see that more people die every year from doctors' errors than from cerebrovascular disease (168,000), diabetes (69,000) or influenza or pneumonia (65,000).18 If it were not for the politics involved - that is, if allopathic iatrogenesis were an infectious disease, rather than a consequence of professional error - major public health campaigns would be directed to alert the public about risk-reduction measures for this underappreciated major cause of death. How is it that these same doctors go on to prevail over doctors with much safer interventions?

The Myth of Superiority of the "Medical" Scientific Method and Clinical Effectiveness

Medical treatments are proven to be safe and effective, right? That is why they are covered by insurance, right? Not so fast. Going back to musculoskeletal medicine, let's look at medical/surgical management of osteoarthritis, one of the most common disorders for which patients seek care. Arthroscopic knee surgery is performed on at least 225,000 middle-age and older Americans each year at a cost of several billion dollars to Medicare, the Department of Veterans Affairs and private insurers,19 yet the results are no better than those obtained from placebo.20 In their 2003 review of the literature on this topic, Bernstein and Quach21 concluded, "Arthroscopy for degenerative conditions of the knee is among the most commonly employed orthopedic procedures, but its effectiveness (like the effectiveness of many surgical operations) has never been proven in prospective trials." How about the "anti-inflammatory drugs" used to treat osteoarthritis? Many of the drugs used to treat osteoarthritis actually accelerate progression of the joint destruction,22 and NSAIDs kill more than 16,000 arthritis patients every year.23 Even though Vioxx was found to be lethally toxic within two years of its release into the American market,24 medical doctors continued to prescribe it and the FDA failed to remove it from the market25 until it killed at least 26,000 to 55,000 patients.26

What about general practice: How well do medical doctors perform? According to internal reviews by clinical researchers and epidemiologists, allopathic physicians commonly deliver care that is "substandard." That is to say, often they do not even follow the guidelines of their own profession.27 The final sentence in the summary of this research reads, "CONCLUSIONS: There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care." Another study found similar results, noting that the quality of care delivered by medical doctors was so poor that it poses "serious threats to the health of the American public."28 The myth that medical doctors consistently deliver high-quality care - like the myth of excellent training and the myth of the medical method - just does not stand up to the data.

Exploding the Myths and Moving Forward

The belief that medical doctors receive a high-quality education based on a rigorous implementation of the scientific method, and from which they go on to routinely deliver high-quality health care, is a myth; it does not stand up to the consistent themes in peer-reviewed research published in major medical journals. Naturopathic physicians are trained in the implementation of all of the necessities for routine outpatient care, and their training in "natural medicine" and "CAM" modalities is unsurpassed. Furthermore, there is no evidence to support positioning the medical profession over the naturopathic profession, particularly when the majority of the diseases of our time are better treated with natural methods. Contrasts and comparisons between allopathic and naturopathic treatments for common conditions will be presented in a future edition of this column. In the meanwhile, let's work toward ensuring that research and policy for natural medicine is supervised by the doctors who actually have the most training in natural medicine: naturopathic physicians.

References

  1. Holman H. Chronic disease - the need for a new clinical education. JAMA 2004;292:1057-9.
  2. DeAngelis CD. Professors not professing. JAMA 2004;292:1060-1.
  3. Vasquez A. Integrative Orthopedics. The Art of Creating Wellness While Effectively Managing Acute and Chronic Musculoskeletal Disorders. www.OptimalHealthResearch.com.
  4. Joy EA, Hala SV. Musculoskeletal curricula in medical education: filling in the missing pieces. The Physician and Sportsmedicine 2004;32:42-45.
  5. Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone Joint Surg Am 1998;80(10):1421-7.
  6. Freedman KB, Bernstein J. Educational deficiencies in musculoskeletal medicine. J Bone Joint Surg Am 2002;84-A(4):604-8.
  7. Matzkin E, Smith ME, Freccero CD, Richardson AB. Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am 2005 Feb;87-A(2):310-4.
  8. Schmale GA. More evidence of educational inadequacies in musculoskeletal medicine. Clin Orthop Relat Res 2005 Aug;(437):251-9.
  9. Click to view it online. Accessed Sept. 27, 2005.
  10. Christopher Murray MD, PhD, director of World Health Organization's Global Program on Evidence for Health Policy. Click to view it online. Accessed July 12, 2004.
  11. Anderson GF, Poullier JP. Health spending, access, and outcomes: trends in industrialized countries. Health Aff (Millwood) 1999;18(3):178-92.
  12. Center for Studying Health System Change. Medical Debt a Problem for Almost 20 Million American Families: Many Face Tough Trade-offs Between Food, Shelter and Medical Care. News Release June 30, 2004. Click to view it online. Accessed Jan. 4, 2005.
  13. Hopkins J. Health care tops taxes as small business cost drain. USA Today. Click to view it online. Accessed Jan. 4, 2005
  14. Phillips DP, Christenfeld N, Glynn LM. Increase in US medication-error deaths between 1983 and 1993. Lancet 1998;351(9103):643-4.
  15. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200-5.
  16. Starfield B. Is US health really the best in the world? JAMA 2000;284(4):483-5.
  17. Holland EG, Degruy FV. Drug-induced disorders. Am Fam Physician 1997;56(7):1781-8, 1791-2.
  18. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291(10):1238-45.
  19. Gina Kolata. A knee surgery for arthritis is called sham. The New York Times, July 11, 2002.
  20. Moseley JB, O'Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002;347:81-8.
  21. Bernstein J, Quach T. A perspective on the study of Moseley et al: questioning the value of arthroscopic knee surgery for osteoarthritis. Cleve Clin J Med 2003;70(5)401,405-6,408-10.
  22. Prathapkumar KR, Smith I, Attara GA. Indomethacin induced avascular necrosis of head of femur. Postgrad Med J 2000 Sep; 76(899): 574-5 and Newman NM, Ling RS. Acetabular bone destruction related to non-steroidal anti-inflammatory drugs. Lancet 1985 Jul 6; 2(8445):11-4 and Brandt KD. Effects of nonsteroidal anti-inflammatory drugs on chondrocyte metabolism in vitro and in vivo. Am J Med 1987 Nov 20;83(5A):29-34.
  23. Singh G. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. Am J Med. 1998;105(1B):31S-38S.
  24. Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA 2001;286(8):954-9.
  25. Topol EJ. Failing the public health - rofecoxib, Merck and the FDA. N Engl J Med. 2004 Oct. 21;351(17):1707-9.
  26. Memorandum from David J. Graham, MD, MPH, associate director for science, Office of Drug Safety, to Paul Seligman, MD, MPH, acting director, Office of Drug Safety, titled "Risk of Acute Myocardial Infarction and Sudden Cardiac Death in Patients Treated with COX-2 Selective and Non-Selective NSAIDs." Sept. 30, 2004. Click to download PDF and "Last year, Graham led a study on Merck's Vioxx that indicated 30,000 to 55,000 Vioxx-related deaths in the U.S., and more still globally." Goldstein R. Published on Wednesday, Feb. 23, 2005 by CommonDreams.org, Click to view it online. Accessed Dec. 4, 2005.
  27. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. 1991. Qual Saf Health Care 2004 Apr;13(2):145-51.
  28. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the U.S. N Engl J Med 2003 Jun 26;348(26):26345.

 



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Date Last Modified - Friday, 17-Oct-2008 12:10:32 PDT