Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

The Real Western Medicine

As a follow-up to the sentence I commented on yesterday, I want to address the second stereotype directed toward real medicine by proponents of alternative medicine.

The claim that Eastern medicine is somehow better, or that Ancient medicine is somehow better, or the claim that Traditional medicine is somehow better.

In the current edition (October 2010) of the American Journal of Emergency Medicine there are 16 original articles published. Out of those 16 original studies, four were by authors entirely in Chinese medical centers, one is by authors in Turkish medical centers, and one is a collaboration between authors at American and Chinese medical centers. This is not at all unusually high concentration of medical research from Eastern medical centers. This in the American Journal of Emergency Medicine.

These studies are examining real medicine, not acupuncture, or reiki, or homeopathy, or some other nonsense.

Killip classification and glucose level in patients with acute myocardial infarction
pages 853-856
Diagnosis of unrecognized primary overt hypothyroidism in the ED
pages 866-870
Early risk stratification with simple clinical parameters for cirrhotic patients with acute upper gastrointestinal bleeding
pages 884-890
The role of the heart-type fatty acid binding protein in the early diagnosis of acute coronary syndrome and its comparison with troponin I and creatine kinase-MB isoform
pages 891-896
Ultrasound-guided pigtail catheters for drainage of various pleural diseases
pages 915-921
Domicile-related carbon monoxide poisoning in cold months and its relation with climatic factors
pages 928-932 [1]

Yesterday, the FDA released a press announcement –

FDA: Possible increased risk of thigh bone fracture with bisphosphonates
Labeling change adds warning about possible risks of long-term use of osteoporosis drugs

. . . .

Bisphosphonates inhibit the loss of bone mass in people with osteoporosis. Bisphosphonates have been shown to reduce the rate of osteoporotic fractures — fractures that can result in pain, hospitalization, and surgery– in people with osteoporosis. While it is not clear whether bisphosphonates are the cause, atypical femur fractures, a rare but serious type of thigh bone fracture, have been predominantly reported in patients taking bisphosphonates. The optimal duration of bisphosphonate use for osteoporosis is unknown, and the FDA is highlighting this uncertainty because these fractures may be related to use of bisphosphonates for longer than five years.

The labeling changes and Medication Guide will affect only those bisphosphonates approved for osteoporosis, including oral bisphosphonates such as Fosamax, Fosamax Plus D, Actonel, Actonel with Calcium, Boniva, Atelvia, and their generic products, as well as injectable bisphosphonates such as Reclast and Boniva.[2]

Do we know if this is because the people using this drug are people who are already at much higher risk for fractures to begin with?

No.

The ethical thing to do is to inform people of the potential for increased risk.

The scientific thing to do is to inform people of the potential for increased risk and to investigate this thoroughly.

This is not something that you will see with alternative medicine, because alternative medicine drugs have never been approved as drugs and are exempt from oversight as drugs. The alternative medicine drugs are deceptively sold as dietary supplements.

This is not different from the disclaimer for horoscopes – for entertainment purposes only.

What about Eastern medicine? Where is the oversight for this? China? How is that made there?

OK. Maybe it is imitation Eastern medicine – faux Eastern medicine. The rip off is always better than the real thing, right?

What about Ancient medicine or Traditional medicine?

Do you really want something that is from a time when the life expectancy was less than half of what it is now?

That sounds really healthy.

The stuff has been around for centuries. It hasn’t changed and it still doesn’t work. And there is no more accountability than any of the other frauds.

Real medicine is not based on where the medication came from, or where the idea came from. Real medicine is based on science. Real medicine is based on what matters –

Can we show that the medication is more efficacious than placebo and safe enough to justify the risk of taking this medication?

If the answer is No, then some alternative medicine people will probably start pushing it, claiming that it has been examined in well done experiments. They will claim that they know it is effective, even though the results of the experiments were negative. They will claim that it is some sort of suppressed medicine that the powers that be do not want you to have. It is true that people do not want you to have this medicine dangerous chemical because the experiments have shown that it is not safe or that it is not any better than placebo – just like the rest of alternative medicine.

When we learn that something is harmful we change the way that it is used in order to do what is best for patients.

Alternative medicine will just ignore a problem, or relabel a problem, when the alternative medicine quacks are informed by people that they have a genuine problem with their fraudulent medicine.

In EMS, we are a prime target for alternative medicine treatments –

MAST/PASG (Military Anti-Shock Trousers/Pneumatic Anti-Shock Garment) provides the equivalent of a transfusion of blood.

OLMC (On Line Medical Command requirements) protect patients.

RLS (Red Lights and Sirens) saves a lot of time.

Replacing blood with NSS (Normal Saline Solution) or LR (Lactated Ringer’s solution) saves lives.

Long board immobilization protects patients from spinal injuries.

Basic EMTs cannot safely apply a spinal clearance protocol.

It is more important to stabilize the head and neck, than it is to assess and treat the patient.

High flow oxygen is good for everybody. If some is good, more is better.

Furosemide (Lasix) is a good treatment for ADHF (Acute Decompensated Heart Failure).

Naloxone (Narcan) is harmless and it helps to identify heroin overdoses.

Intubation is airway control.

Traction splints protect against femoral artery lacerations.

Et cetera,

EMS Mythology Starter Kit

A much better approach is described by 510Medic in Clinical Research – The Basics.

Footnotes:

[1] American Journal of Emergency Medicine
Table of contents and abstracts from each paper
October 2010 Table of Contents

[2] FDA: Possible increased risk of thigh bone fracture with bisphosphonates
Labeling change adds warning about possible risks of long-term use of osteoporosis drugs
FDA (Food and Drug Administration)
For Immediate Release: Oct. 13, 2010
Media Inquiries: Karen Riley, 301-796-4674, karen.riley@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA
News Release

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