Choosing the Best Treatment - part two (May 13, 2014)
I want to begin by repeating this from last week: I strongly recommend you begin your search for a medical solution by going to the appropriate doctor for an accurate diagnosis. Your body has a limited number of ways to respond to any problem, and a symptom (particularly a general one like unusual fatigue, as well as almost any type of pain) can have many different causes. The internet is for AFTER you get a diagnosis. (Also, there may be someone you work with who tells you they had the exact same problem, and it was yada yada and they did thus and such. Please let me assure you that they did NOT have the exact same problem that you do, and you have no idea whether their solution will be yours.)
Ok -- now you are at the doctor, the exam and tests are finished, and you have been given The Diagnosis. Make sure that you understand precisely what your problem IS. Do not be intimidated by the whole Authority thing -- ask questions until you feel like you've got a grip on what is happening. You need to understand it thoroughly or you won't be able to properly evaluate possible solutions. Try to bring someone with you for both another perspective and for moral support. Write things down, particularly if there is technical jargon that you are having trouble with. Then (among others you might have), ask these questions.
-How does the treatment that you are recommending work? (Is it a true solution, or is it just meant to quiet symptoms?)
-What are the problems associated with that treatment? (It may not be worth the side effects.)
-What happens if I don’t follow this treatment? And, what happens if I don’t treat this problem at all? (Many things do go away by themselves eventually. And maybe nothing will happen except some continued discomfort. But you’d better know for sure.)
-What other treatments are available? (You may have to go elsewhere for a good answer to this one because experts are really just experts in their particular field of knowledge. However, in that field they should be able to answer ALL your questions.)
-Can I treat this just by changing my habits and lifestyle? (Remember you would have to actually DO this, not just think about it, and be honest with yourself.)
Last week I said that you shouldn’t necessarily avoid a treatment because it has not been “proven” to work. Partly because relatively few treatments have actually been proven. Still, that statement requires a little more explanation.
EBM (evidence-based medicine) does not sponsor new research. It only evaluates what science has made it to publication in respectable journals. If research hasn’t been done in an area, or the researcher or his/her sponsor did not like the results (and that last happens all the time, particularly with medications), there simply won’t be any evidence to evaluate.
Research is money-driven, which means that most research is funded by individuals and organizations that have a vested interest in the outcome of that research. This means not only that you have to automatically question the study done by Grandma Corporation that proves that Grandma’s High-Fiber Muffins will make you more regular. It also means that even though drinking a big glass of water in the morning may work just as well (or better) at accomplishing that same purpose, there is no money motivation for anyone to establish that fact. As a result, there isn't much research getting done in the U.S. these days that isn't profit driven.
So how can you judge a treatment that is new, controversial, or otherwise lacks the solid scientific basis we would like so much to have? I hope you can stand one more newsletter on this topic, because that is I want to address next time.
--dr. diane holmes
Copyright © 2014
I want to begin by repeating this from last week: I strongly recommend you begin your search for a medical solution by going to the appropriate doctor for an accurate diagnosis. Your body has a limited number of ways to respond to any problem, and a symptom (particularly a general one like unusual fatigue, as well as almost any type of pain) can have many different causes. The internet is for AFTER you get a diagnosis. (Also, there may be someone you work with who tells you they had the exact same problem, and it was yada yada and they did thus and such. Please let me assure you that they did NOT have the exact same problem that you do, and you have no idea whether their solution will be yours.)
Ok -- now you are at the doctor, the exam and tests are finished, and you have been given The Diagnosis. Make sure that you understand precisely what your problem IS. Do not be intimidated by the whole Authority thing -- ask questions until you feel like you've got a grip on what is happening. You need to understand it thoroughly or you won't be able to properly evaluate possible solutions. Try to bring someone with you for both another perspective and for moral support. Write things down, particularly if there is technical jargon that you are having trouble with. Then (among others you might have), ask these questions.
-How does the treatment that you are recommending work? (Is it a true solution, or is it just meant to quiet symptoms?)
-What are the problems associated with that treatment? (It may not be worth the side effects.)
-What happens if I don’t follow this treatment? And, what happens if I don’t treat this problem at all? (Many things do go away by themselves eventually. And maybe nothing will happen except some continued discomfort. But you’d better know for sure.)
-What other treatments are available? (You may have to go elsewhere for a good answer to this one because experts are really just experts in their particular field of knowledge. However, in that field they should be able to answer ALL your questions.)
-Can I treat this just by changing my habits and lifestyle? (Remember you would have to actually DO this, not just think about it, and be honest with yourself.)
Last week I said that you shouldn’t necessarily avoid a treatment because it has not been “proven” to work. Partly because relatively few treatments have actually been proven. Still, that statement requires a little more explanation.
EBM (evidence-based medicine) does not sponsor new research. It only evaluates what science has made it to publication in respectable journals. If research hasn’t been done in an area, or the researcher or his/her sponsor did not like the results (and that last happens all the time, particularly with medications), there simply won’t be any evidence to evaluate.
Research is money-driven, which means that most research is funded by individuals and organizations that have a vested interest in the outcome of that research. This means not only that you have to automatically question the study done by Grandma Corporation that proves that Grandma’s High-Fiber Muffins will make you more regular. It also means that even though drinking a big glass of water in the morning may work just as well (or better) at accomplishing that same purpose, there is no money motivation for anyone to establish that fact. As a result, there isn't much research getting done in the U.S. these days that isn't profit driven.
So how can you judge a treatment that is new, controversial, or otherwise lacks the solid scientific basis we would like so much to have? I hope you can stand one more newsletter on this topic, because that is I want to address next time.
--dr. diane holmes
Copyright © 2014