Feb 19 2010

Boobs and Woo

I’m quite ashamed to admit that I’ve been duped by complimentary and alternative medicine (CAM). A long while ago I mentioned to my general practitioner (GP) that I suffered from breast tenderness, or mild mastalgia, just prior and during my period (i.e. cyclical mastalgia). She suggested I try Evening Primrose Oil as that should help.

I thought fair enough and sauntered off to Boots to buy a jar. As it turns out, I’ve never actually got round to trying it. Then recently, with all of the hullabaloo around homeopathy, I decided to look up Evening Primrose Oil (EPO) on PubMed to find this:

Evidence-based management of Mastalgia: a meta-analysis of randomised trials

Which states:

“EPO did not offer any advantage over placebo in pain relief”

Now this pissed me off lots and lots. I had believed that my medically trained GP would suggest something that was evidence-based and had not done so because either a) she was unaware of the current evidence and/or was one of these CAM-peddling NHS doctors or b) she was trying to placebo my ass. Both of which are troubling.

Firstly, if it was because she was unaware/a CAM peddler then this undermines my trust in the medical opinion of NHS doctors (and none of this “but she was only a GP”). Not everyone is going to check their medical advice online or if they do they are more likely to come across pseudoscience and quackery than know where to look for a systematic review. We can’t check everything all the time and so generally we rely on the expertise of those we assume will have more knowledge than us.

Obviously this was a very minor aliment for me and so I didn’t check. Most people on finding out that they have a serious illness do and should investigate it as much as possible.

But secondly, if she was trying to palm me off with a placebo then I’m fucking livid. There is over-prescribing in certain areas of general practice because people go expecting an intervention for their health problem. I, however, didn’t want an intervention and mentioned the jublies pain as an aside.

If she knew that EPO only acted as a placebo not telling me has left me feeling stupid and lied to. If I had had all the information at the time I would have made a different decision on the basis that the tit ache isn’t that bad, just a mild annoyance, and chocolate is my preferred placebo.

This of course links nicely to homeopathy; if it is simply a placebo then doesn’t the positive outcome justify the means? The placebo effect is real and therefore if homeopathy works solely as a placebo can’t it still ‘help’?

The significance is displayed in my outrage at finding out that EPO has no evidence-base for treating bap pain. I felt stupid and disempowered. I had been made an unwilling victim of marketing over substance. And this is what is wrong about homeopathy; its marketing and spin masquerading as authoritative medical knowledge. It dupes individuals into thinking they are taking control of their own health when in fact they are not being given access to the full facts.

If you want to know what my GP should have done, here’s a handy guideline flow-chart from NHS Lothian (*cough* her Health Board).

For people with ouchy knockers there’s some helpful guidance here and here.

May 24 2009

Women and CAM

I was reminded of the women and complimentary and alternative medicine (CAM) ‘problem’ by this blog about Professor Edzard Ernst’s talk at the last Skeptics in the Pub (which I missed, slap wrists). He mentioned that he had been talking to a female homeopath and as an aside said that most homeopaths are women. When quizzed on this later on he said:

All surveys show that the typical user of complementary medicine (more specifically homeopathy) but complementary medicine is… I call it “The Four F’s” – Around forty, female, fertile… and I was going to say “fucking mad”

Now I have blogged on this before and do concede that indeed women are the bigger consumer of CAM, and it seems many are practitioners. So as I asked last time – why?

Purely on anedoctal experience it tends to be either or both based on a) bad experience of ‘orthodox’ medicine and b) out of desperation. One woman I know was having trouble conceiving and so went for fertility treatment. This treatment was ultimately unnecessary because the cause of their infertility was, as it is for most 30-something professionals, a lack of sex (I’m not medically trained but I believe that is key). The treatment did however result in alapecia for her. Both of these events are pretty high on the scale of emotionally devastating and led her to go to a snake-oil salesman to treat the hair loss and later to a Chinese herbalist for fertility ‘things’. A combination of these treatments not working and me suggesting that it might take less effort if she just set fire to her money in the comfort of her own home, she now accepts that they weren’t the best course of action but that in both circumstances she was distraught and needed help from somewhere.

Postscript: she now has two children and her hair grew back albeit completely white, which I think is rather cool.

In a previous job I also attended a seminar on Do Not Resuscitate orders arranged by the then Disability Rights Commission. I was representing a certain medical professional body and was therefore treated with suspicion bordering on contempt. This was because the politicised disabled people involved in the seminar had had awful experiences of the NHS and at the hands of doctors hence their admirable drive to get involved in disability rights work. These people would have been badly treated, misdiagnosed, ignored, possibly abused and so were aggressively opposed to doctors deciding on their fate when they were incapacitated. They did not trust doctors to make decisions that they felt would be based on prejudiced views of a disabled patient’s quality of life. The health professionals in the room discussed the nature of resuscitation and how rarely it even works but it was difficult to shrug of the, in many cases well-founded, suspicion of doctors.

So my point is, that although these anecdotes may illustrate experiences that may lead people towards CAM or at least away from the NHS, not all women have had terrible experiences of doctors, feel alienated from the experience of the NHS or are in an extreme health situation. This makes me wonder whether gender inequality in society as a whole has some bearing on this. Is CAM more empowering for women? Is it because CAM sells you the facade that you are taking your health into your own hands? Is the communication of CAM better i.e. the therapeutic relationship is more important to many women? These are genuine questions, because I really don’t know.

Also, given Prof Ersnt’s suggestion that users of CAM are “around forty, female, fertile and … fucking mad” could there also be something in – now bear with me here – the tradition of the witch? The Witch has been a potent symbol for centuries and although it has been interpreted as a sexist stereotype of old, ugly women, the witch has also be reclaimed by feminists as the symbol of a strong, powerful if maleficent woman. (It important to point out the various cultural variations, e.g. in Central and Eastern European during the Middle Ages witches were believed to be male or female, witches being predominantly female is mostly a Western European conception, but that aside…)

Do female CAM practitioners fit in somewhere in the tradition of strong female ‘healers’? Is there any connection to the reclaiming of the ‘witch’ by feminists in the 60s/70s and its reinvention into the emancipatory goddess rituals? Of course I’m not blaming feminism for CAM, but it does seem likely that there is some connection between people feeling marginalised from ‘orthodox’ medicine and therefore veering into what are perceived as empowering alternatives. My only hope is that with the vastly increased number of female doctors coming up through the system this may have an affect on women’s perception of medicine.