A couple of weeks before my medical finals late last year I sat down in the waiting area of the Christchurch rheumatology clinic. I struck up conversation with the only other person there, a man in his late forties. The story he told me about his arthritis made my few remaining strands of hair stand on end.
This unfortunate gentleman (whom I’ll call “Barry”) had suffered from rheumatoid arthritis in his hands and feet for about seven months. Shortly after the start of his symptoms he consulted his general practitioner who advised him, and provided him with a typical course of physiotherapy and aspirin-like drugs to try to prevent loss of function, and to relieve the inflammation and the pain.
This approach didn’t seem to be working and shortly thereafter Barry consulted a naturopath in his suburb. The experience completely changed his life.
Barry was an uncomplicated man, surviving on his own, on an unemployment benefit. A weekly visit to the naturopath cost twenty dollars, which initially seemed reasonable, but the remedies prescribed cost a further eighty dollars each week. These were initially in the form of homeopathic pill preparations; subsequently there were caustic foot baths (“which made my skin fall off”) and magnets to wear. Then there was the list of forbidden foods which, he said, “was practically everything I ate”. Onion soup was given the green light however, and Barry had quite literally attempted to live on this for the months until his rescue. He felt there was little option though, as he had no money to buy food now anyway. This continued for a considerable time and Barry’s return for “therapy” each week was partly promoted by the naturopath telephoning him each morning and each night, every day, reminding him to do so.
Barry remembers no attempt to formally test whether or not his arthritis was improving. He felt there was no improvement.
Old neighbours called around one day, not having heard from him for a time. They found Barry lethargic, pale and malnourished. He had the feeling that the naturopath had control over his mind, and he wanted to kill himself. The neighbours’ very humane response to this was to temporarily remove him from his house, and simultaneously clean it and contact the Arthritis Foundation. And Barry found himself back in medical care, where I met him.
There was a post script to this ghastly affair. Barry called the naturopath to tell her that he would no longer be attending, and that he would be submitting the remedies he had left to “the DSIR” to see if she had been poisoning him. He was told that unless any remaining medicines were returned to her within twenty-four hours the police would be informed that he had stolen them. He took them back.
How could this have happened?
The chronic nature of many rheumatic disorders often leads sufferers to seek treatments alternative to those given by their doctors1. In one study published in England2, 40% of Scandinavian rheumatoid arthritis sufferers had consulted a practitioner in at least one of the following disciplines (a further 3% were unclassified): acupuncture, anthroposophical medicine, astrology, cell therapy, auriculo therapy, enzyme therapy, faith healing, spa treatment centre, herbalism, homeopathy, hypnotherapy, iridology, manipulation, naturopathy, neural therapy, hand healing.
An article in Pediatrics3 states that 70% of sufferers of juvenile arthritis used “unconventional” remedies at some time.
Homeopathy is possibly the most widely available alternative therapy in Christchurch, but there is a real smorgasbord of alternatives now as readers will know. Even my much admired medical handbook4 appears to support the system, referring to a British Medical Journal paper5 and stating that an analysis of the clinical trials suggests real benefit. Closer scrutiny of that very article however, does not to my mind bear this out, and the conclusions the authors draw from their own analysis are contradictory.
Some authors in apparently reputable medical journals are startlingly uncritical. Most authors suggest that more research must take place. Not so Skrabanek, who says “…this leaves the sufferers, and also healthy people labelled with non-existent diseases, bleeding prey for the sharks roving the seas of medical ignorance”.6
Questions remain. Why do people seek out alternative therapies, and often believe uncritically in them? Are they dangerous?
My belief is that as a group, we are not fulfilling all of our duties as caring doctors. Patients who visit alternative practitioners tend to have less satisfaction in their regular doctor in psychosocial ways than those who have never consulted an alternative medicine practitioner2.
I think that we would all accept that our medicine may fail to arrest the biological progress of a patient’s disease. But if we also fail to recognise and help with the psychological and social aspects when they consult us, help in all aspects of a disorder may be sought elsewhere. This could be registered as a dissatisfaction “with the dehumanising aspects of modern technological medicine”6.
As to the hotly-debated question of dangerousness2, arguing against any particular danger is the innocuous biological inactivity of the majority of alternative therapies — homeopathic remedies made in the classic way contain no active ingredient, and can therefore do the patient no harm. But surely this is too simplistic. Many skeptics would consider these “therapies” potentially dangerous because the patients they may be encouraged to waive their usual medication, they pay large sums of (unsubsidised) money, acquire weird false hopes, and are seduced into accepting bizarre magical thinking. And they don’t get their diseases treated.
References
1) Andrade, L., Ferraz, M., Atra, E., Castro, A., Silva, M. “A randomized controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis.” Scandinavian Journal of Rheumatology 20(3): 204-208, 1991. Return to text
2) Visser, G., Peters, L., Rasker, J. “Rheumatologists and their patients who seek alternative care: an agreement to disagree.” British Journal of Rheumatology 31:485-490, 1992. Return to text
3) Southwood, T., Mallelson, P., Roberts-Thomson, P., Mahy, M. “Unconventional remedies used for patients with juvenile arthritis.” Pediatrics 85(2):150-154, 1990. Return to text
4) Collier, J., Longmore, J., Harvey, J. Oxford Handbook of Clinical Specialties (3rd Edition). Oxford University Press, Oxford, 1991. Return to text
5) Kleijen, J., Knipschild, P., ter Riet, G. “Clinical trials of homoeopathy.” British Medical Journal 302:316-323, 1991. Return to text
6) Skrabanek, P. “Paranormal health claims.” Experientia 44(4):303-309, 1988. Return to text
