Science based medicine vs. defiance based medicine

Boy with No sign

Why, in the absence of any scientific evidence to support it, has anti-vaccine advocacy become so popular?

Why, in the absence of any scientific evidence to support it, have homeopathic products that are nothing more than water become big sellers?

Why, in the absence of any scientific evidence to support it, does anyone pay hard-earned money for cranio-sacral therapy?

Doing the exact opposite of what authority figures recommend is a sign of immaturity, not deliberation.

These are questions that can be asked of any of the myriad forms of quackery that travel under the banner of “alternative health,” a multi-billion dollar industry that is burgeoning despite the fact that it is based on nonsense.

Doctors, scientists and public health officials often imagine that the problem reflects a lack of understanding of basic science. But opposition to science based medicine has nothing to do with science at all. It’s really defiance based medicine, predicated on the bizarre belief that defying authority is a form of empowering anti-elitism, distinguishing independent thinkers from the pathetic “sheeple” who are nothing more than followers.

In contrast to science, which is defined by the principles that causes and consequences are knowable but unpredictable, alternative health is entirely predictable. It’s just the mirror image of science based medicine.

Consider:

If it works claim it doesn’t. Vaccine rejection is the paradigmatic form of alternative health. Vaccines are one of the greatest public health advances of all time. That’s why the heart of anti-vax advocacy is the assertion that vaccine preventable illnesses were disappearing before the advent of vaccines.

If it doesn’t work, claim it does. Eating right, exercising, and taking herbs and supplements can’t prevent vaccine preventable diseases. There’s no evidence that it can and no evidence that it does so. That hasn’t stopped anti-vax advocates from insisting that the key to health is diet.

If it’s safe, claim it’s dangerous. Whether it’s vaccines, medications or GMOs (genetically modified plants), it is an article of faith among alternative health advocates that side effects are scary conditions — autism, autoimmune diseases — whose causes are not yet understood.

If it’s dangerous, claim it’s safe. Whether it’s colloidal silver, bleach enemas for autistic children, and even turpentine (I kid you not), alternative health is full of “remedies” that are deadly.

If it’s natural, claim it’s perfect. Because everyone knows that natural = safe, even though there is nothing in nature that is perfect and plenty (hurricanes, rattlesnakes, earthquakes) that is naturally deadly.

If it’s technological, claim that it’s harmful. Alternative health advocates labor under the delusion that technology has led to disease when the opposite is patently obvious. There was a time when all food was organic, everyone exercised and the only remedies were herbs, and the average life expectancy was — 35 years. In 21st century industrialized countries, massive portions of foods filled with artificial ingredients are plentiful, exercise may be limited to operating the TV remote control, and everyone seems to be on medication of some kind, yet the average life expectancy now approaches 80.

If it’s true, claim it’s false. AIDS isn’t caused by HIV; it’s a government lie. Microcephaly isn’t caused by Zika virus; it’s caused by pesticides. Medications don’t save lives; they kill people.

If it’s false, claim it’s true. A list of easily available, relatively inexpensive a substances claimed to cure cancer is longer than my arm, yet none of them — not a single one — works as advertised.

If it’s nonsense, claim it’s science. Homeopathy is nonsense. Cranio-sacral therapy is nonsense. Eating placentas. Meanwhile people are spending their money on treatments that don’t merely fail to work; they could never work.

If it’s science, claim it’s nonsense. Chemotherapy supposedly doesn’t work. Antibiotics supposedly do nothing more than create resistant organisms. Medicine supposedly doesn’t save lives; it kills people.

If someone is an expert, claim his education is worthless. Don’t listen to immunologists about vaccines, oncologists about cancer, or obstetricians about childbirth. They’ve been indoctrinated in a technocratic model of illness and disease. What do they know?

If someone is an amateur, insist she is an expert. Jenny McCarthy is a prophet of immunology knowledge; Suzanne Sommers is an oncologist, and no one knows more about childbirth than washed up talk show host Ricki Lake.

It’s not merely defiance that is the engine of alternative health, but knee-jerk defiance. That’s how alternative health advocates can oppose a Zika vaccine that doesn’t yet exist or a genetic cause of autism or cancer that hasn’t been elucidated.

Yes, there are many societal ills that stem from the fact that previous generations were raised to unreflective acceptance of authority. It’s not hard to argue that unreflective acceptance of authority, whether that authority is the government or industry, is a bad thing. BUT that doesn’t make the converse true. Unreflective defiance is really no different from unreflective acceptance.

Unreflective defiance is just the flip side of unreflective acceptance. There’s nothing praiseworthy about it. Only teenagers think that refusing to do what authority figures recommend marks them as independent. Adults know that doing the exact opposite of what authority figures recommend is a sign of immaturity, not deliberation.

Alternative health exists in opposition to science based medicine not because advocates don’t understand science (although they don’t); it is exists because some people confuse unreflective defiance of authority with independent thinking. But belief in alternative health isn’t independent thinking; it’s not thinking at all.

  • Anon

    I used to work in the same university department where midwives were taught. The research coming out of the midwifery department was just plain bad research. The lecturers didn’t know how to run or interpret statistics, even the qualitative research was substandard. The doctoral students were pretty much left to figure things out as best they could. Once I mentioned to a senior midwifery academic (whom I have a lot of respect for) that a particular internationally renowned midwifery researcher had used biased sampling in her research which made the findings unreliable. My colleague’s response was, “The researcher is a dear friend of mine, so I don’t want you to say this”. That was the end of the discussion and it indicates how some midwifery research is evaluated. Friend = good researcher.
    I have seen very little ‘scientific method’ in midwifery research in this department. Everyone uses research jargon, but midwifery professors lack basic understanding of the research process, and they lack basic research skills. I would not apply any of the “evidence” emerging from this department to real mothers and babies. I can only hope midwifery researchers in other countries have a better grasp of research methods than those in Australia.

  • Platos_Redhaired_Stepchild

    “Only teenagers think that refusing to do what authority figures recommend marks them as independent. Adults know that doing the exact opposite of what authority figures recommend is a sign of immaturity, not deliberation.”

    Yes, it’s like people who brag they ‘go against the herd’ aka Maverick Syndrome.

    https://www.youtube.com/watch?v=VECtHHQjCqg

    Hey, Dumb Dumb, this is what the herd is running away from. The fact you’re running toward a gory, bloody death doesn’t make you cooler, smarter, or better educated than the herd.

  • mabelcruet

    I think a large part of the problem is the issue of false equivalency and false balance in the media. In interviews on TV or in print, believers in various alternative therapies are afforded a platform without having their claims challenged in any significant way. A medic might be rolled out to discuss current medical therapies for a particular health issue, but to the audience the alternative therapy is being presented as being the equal of the standard medical therapy, without explaining that the medical therapy is generally robustly tested, tried and demonstrably superior. Rejection of orthodoxy is seen as a way of ‘proving’ that you can think for yourself, take control, not fall for the ‘lies’ of ‘big pharma’, that you’re not one of the ‘sheeple’ and all the other crap that is spouted.

    • Dr Kitty

      Look at the recent RCOG hyperemesis guidelines.
      The BBC news website headline is “Ginger may be an option for morning sickness”.
      The guideline actually is very clear that genuine hyperemesis will not settle with diet or lifestyle change and alternative therapies and requires prescription anti-emetics, possibly steroids and maybe even parenteral nutrition.

      As for ginger, it says that is is an acceptably safe option for very mild symptoms in women who don’t want medication. Not exactly a ringing endorsement.

      I expend huge amounts of time and energy telling women that no, they shouldn’t be vomiting three or four times a day, I can give them safe medication which will help and that vomiting is more dangerous for their baby than tablets.
      And there is the BBC website promoting ginger.

      TBH what wins women over is saying “I had what you had. I was miserable. I wouldn’t prescribe you anything I wasn’t happy to take myself. These tablets helped make my pregnancies bearable, I think you should consider taking them”.

      I shouldn’t have to do that, but it seems to be the only thing that works.

      • mabelcruet

        And this is exactly why I would make the world’s worst GP! I think I would find it very difficult to deal with people who come and consult with you but won’t listen to what you say and won’t take any advice-why bother taking up an appointment if you refuse to work with the doctor? I’m not saying paternalism is right, but its like they need your permission to go off-grid and try an alternative form of therapy (and then blame you when it doesn’t work). Fine, if you want to burn your nose off with Black Salve rather than have minor surgery, then go right ahead, but don’t expect me to stand by and cheer you on doing it! Sorry, I think I was at the back of the queue when patience and empathy were being handed out…

      • Cody

        You have to admit though that this specific example has a lot more to do with thalidomide than alternative medicine. I’m happy to take any prescription my doctor prescribes to me, but any time I hear about medication for morning sickness I have a bit of an involuntary physical reaction.

      • Rachel

        Diclegis all the way!

  • Linden

    OT and possibly TMI but I used to be very prone to getting UTIs, any time I forgot to get up and go pee. I probably had to have a course of antibiotics every few months, and this had been going on for years.
    It’s been 2 years now, and the solution seemed to be: get pregnant and have an episiotomy. I think there was something up that made my pelvic floor as tight as a nightmare steel trap.
    I am very glad of this, as I was probably going to end up as the incubator for the antibiotic-resistant bacterium that was going to wipe out all life on earth.

  • Sue

    “the bizarre belief that defying authority is a form of empowering anti-elitism, distinguishing independent thinkers from the pathetic “sheeple” who are nothing more than followers”.

    Indeed. But here’s the irony: those who think they are being “defiant” by rejecting orthodoxy are running straight into the arms of the ultimate paternalists – providers who offer simplistic solutions, and sell you placebos.

    During the decades that medicine has worked to become less paternalistic, where doubt and decision-making are to be shared between clinician and patient, the “New Paternalists” offer simplistic, directed solutions under the guise of rebellion. By validating people’s concerns with a serious-sounding “diagnosis”, always expressing confidence and always offering a remedy, they entice the vulnerable. It’s just another type of salesmanship.

    • Chi

      And at the same time, they think THEY are the elite for their defiance, for their ‘special’ knowledge that only THEY possess.

  • Irène Delse

    That’s a great article. I think it’s spot on, some people seem motivated by some sort of “anything but the mainstream” mantra.

    I heard recently about a couple of friends-of-a-friend I hadn’t seen since about 20 years. This is a tragic story. They had a young boy who was having an increasingly difficult time at school. I wasn’t told what exactly was the problem, but the child was obviously unhappy and didn’t do well. The family consulted doctors and child psychologists by to no avail. In his early teens, his parents pulled him out of the public school system and enrolled him in a Waldorf-Steiner school. He seems to have been happier there, at least in the beginning, but his troubles continued. He wasn’t feeling more at home in society. In fact, at age 19, he took his own life.

    It must have been absolutely devastating to his parents. However, I learned that they are blaming his death on… the public schools. And fund-raising to open a new Steiner school in their home town. What gives? The “alternative” school failed their boy as much as the regular one, and anyway, this kind of deep-seated problem is beyond the scope of mere pedagogy.

    The poor kid must have had some sort of psychiatric disorder – and sadly, went undiagnosed. I don’t know what kind of HCP his parents brought him to, exactly, but if it was a psychologist of the Freudian school (not a rare thing in my country, alas), they may well have sent the family on the wrong path too. (And that’s of the boy and his parents weren’t on denial about mental illness, another not rare occurrence.)

    I would have totally understood if the parents had used the case of their child to raise awareness about the shortcomings of childhood psychiatry, or to get better options for “problem kids” within the education system (screening for mental illness, assistants for children with special needs, etc.). But to just say “mainstream bad, alternative good”? They have retreaded themselves in an alternate works of their own.

    • mabelcruet

      I’ve posted this before, but I was involved in a case where the mother was insisting on a homebirth and refused pointblank to go to hospital until she got to T+21-she was unwell on admission, emergency section within half an hour of arrival but the baby was stillborn. Turned out that there was severe acute infection probably present for several days. The mum then litigated against the hospital insisting that it had caused the death of her baby.

      Some people believe what they will despite all evidence to the contrary-its easier to blame someone else rather than accept that you as an individual might be at fault.

  • Madtowngirl

    I have had a cold for about a week, and it’s just gotten worse, rather than better, while I tried to treat it with OTC medicine. Now, I’m sure when I woke up in a coughing fit so bad I couldn’t catch my breath this morning, I’m sure I could have Googled natural remedies for colds. But instead, I made an appointment with my doctor.

    Turns out I have pneumonia. I suppose the hip thing for me to do would be to go outside and sun my lungs or some garbage. Instead, I’m loading up on the antibiotics and inhaler I was prescribed. Huh, suddenly I can breathe again.

    • Fleur

      Get well soon!

      Maybe I’m being unfair but I don’t seem to come across an awful lot of blog posts about “How I spent weeks treating my whooping cough/ pneumonia/ broken arm with natural remedies even though it was f***ing agonising and I wanted to die” – it usually seems to be their kids that these people are treating as guinea pigs (in the same way that a badly staffed and ill-planned home birth is fine for the baby but those stories seem to end in a quick dash to hospital the moment the mum develops complications).

      • Madtowngirl

        Thank you!

        You may very well be right. I couldn’t imagine putting my child through this hell, it was hard enough watching a cold run its course with her. It would feel like child abuse to force her to endure an illness that could be easily and quickly treated with modern medicine.

    • Kelly

      I have had that without the pneumonia part for a month. I hope the meds help you and get better soon. It is awful and so hard to sleep. All they told me to take was mucinex and try the netty pot which never worked for me.

      • Irène Delse

        Hope you get better soon. I can empathise, I’ve had more episodes of viral URI than I care to remember. Mucinex, cough syrup, throat lozenges and washing the nasal cavities with sterile water (I use the single-dose thingies intended for babies, I don’t bother with neti pots) is what works for me. Well, actually, it helps the symptoms while the immune system does the real job. Takes about a month until I can say I’m back to normal.

      • MI Dawn

        Ugh. Neti pots. I can’t even use nose drops; they make me retch. And the last time my MD suggested the neti pot, I asked her if she wanted me to throw up in her office or in the waiting room. She hasn’t suggested it since! 🙂

      • Wombat

        Ugh, been there done that, didn’t like it but still done it again too many times over. URI > bronchitis > do it again next month.

        I loved (yay sounding like I’m ready to make the next version of Lean) Tussionex a lot for being able to sleep/if cough was unproductive, and even if they’re not usually recommended an Albuterol/Long Acting inhaler combo usually did wonders too.

        One doctor (who I questioned kind of strongly as running up the bill) wanted to do a LOT more investigative stuff right off the bat (sinus CT to start, new allergy testing, adult onset asthma, etc etc) but having thought about it more it seems less unreasonable than it did at first when I had dollar signs in my eyes and didn’t really super care for him as well. Some of it, anyways.
        It was finally long term better for a while after Dr.$ so that killed a fair bit of my motivation. Starting to feel yucky again though (balloon-y head and gross/stuffy nose) so been thinking about it a lot more. Probably going to have to hit my (thankfully relatively low) out of pocket this year, so once it’s not costing me as badly perhaps we will. I hate my insurance company anyways so they can bite into their profits some just this once… (I know that’s not a sustainable thing or how I should look at the system as a whole but still, let a girl have her maniacal fantasies occasionally c:< )

    • moto_librarian

      Ugh. I’m glad you saw your doc. I had pneumonia last August after a cold that just refused to exit my chest. I’m also an asthmatic, so it was a BFD. I just got my Prevnar 13 shot last week, and will follow up with PneumoVax in six months. Pneumonia is the pits.

  • Dr Kitty

    OT : Just checking in, as I haven’t been about for a while.
    I’ve had some family drama here, which I won’t go into, except to say that I’m eternally grateful for the NHS, everything is going to be OK, and it sucks being far away from family when they are sick.

    • demodocus

      *hugs*

      • Dr Kitty

        Thanks guys.
        Unfortunately my parents can now compare and contrast the experience of sitting through emergency and elective spinal surgery on their children.

        All good with my family, but very dicey for a while.

        • Who?

          That’s not a comparison you want to experience. We never stop being parents, no matter how old we and our children are.

          Glad things are on the upswing.

    • Sue

      Good to have you keep in touch.

    • MI Dawn

      Glad to know you are around. I was wondering.

    • moto_librarian

      Hope everyone will be on the mend very soon. I’m so sorry that you’re far away from those that you love. That’s so hard.

    • Charybdis

      Good to see you again. I was wondering, and hoping that it was nothing catastrophic.

      I’m glad things are going to be OK for you all.

    • Montserrat Blanco

      I am glad things are better. Lots of hugs.

    • mabelcruet

      When it works, which actually is most of the time, the NHS is brilliant. It’s usually great in emergencies in my experience. My dad survived an out of hospital cardiac arrest-he very conveniently arrested in front of the paramedics he’d just called to help with grandad who had fallen out of bed and broke his hip. A bit of DC, and 90 minutes later he’s in the local cardiac unit getting hot stented. Home within 5 days-he still hasn’t accepted that he technically died for a minute or a two. And grandad got his new hip-dad caused a few worries on the ward as he kept unfastening his monitors to head downstairs to the orthopedic ward to visit. Honestly, families-if you didn’t love them you’d want to slap them!

      Hope yours are doing well-they will be in good hands.

      • Dr Kitty

        Yep.
        Up and about, hopefully home by the weekend.
        An accident hundreds of miles from home, ambulance transfer to specialist hospital, surgery within 24 hrs, next of kin put up in nearby hotels, physio and rehab organised.
        Excellent care all round and no complaints.

        It has been a difficult few days, but it is all going to be ok.

      • Who?

        Glad they’re both okay. And yes, families!!

        Timing is everything. My friend’s daughter had her first epileptic seizure while she was on the back of a motorbike, stopped at traffic lights, with an unoccupied ambulance behind them. The ambos saw her fall off, scooped her up and the rest, as they say, is history.

        I think her biggest immediate problem was my friend finding out she’d been catching lifts on a motorbike…

    • Mishimoo

      Hope everyone heals up quickly. Thank goodness for the NHS!

  • guest

    I was thinking about all the nonsensical suggestions around yeast infections this weekend, and I do understand why there’s so much emphasis on home remedies for that, at least – it’s because the medical treatments can be so ineffective, expensive, and hard to get. When medicine doesn’t have good answers, I can understand stuffing yogurt and garlic up your vagina in a desperate attempt to do *something* to make the itch go away.

    But vaccines *work* and they’re pretty simple to get, so the natural remedy stuff has gone way beyond an attempt to fill in the gaps of science-based medicine.

    • Wombat

      The yogurt always got me. You want me to put more sugar where?? And then just have it all end up on a pad anyways, fairly quick I’d think… Or I guess wearing a yogurt tampon… on second thought I don’t want to know or double check what they actually do.

      Even OTC yeast infection treatments are great first line options (though often similar on the mess, blegh – but at least they come with other options, unlike yogurt!) but I feel a lot of women continue to rely on them when they cross the barrier into ‘complicated’/unresolving/frequently recurring presentations and/or have cofactors.

      To take that down another step (or 3) to rummaging around in the dairy part of the fridge?? Just why. Especially when many of the same probably make homemade yogurt – which is usually fine but increases the ‘you need to use it quickly because it may be prone to increased contamination’ factor. No thanks.

      • guest

        For fun, I made a list of everything I could find online that was suggested as a treatment you put in or on your vagina/labia. This was my full list:

        Garlic
        Coconut oil
        Yogurt
        Apple cider vinegar
        Tea tree oil
        Cranberries
        Boric acid (which is also used to kill roaches and other bugs – but this one has some medical support behind it – the CDC mentions it as treatment for a particular type, however the CDC does NOT recommend it as a home treatment, which the internet does)
        Lemon juice
        Potassium sorbate
        Hydrogen peroxide
        Thyme
        Grapefruit seed extract
        Black walnuts
        Aloe vera
        Chamomile tea

        It’s like part science experiment, part kitchen recipe, but neither of those things should be mixed up in my vagina! I’ve had some bad experiences with the OTC creams – the treatment is worse than the disease, as far as the burning and itching goes. So I get looking for alternatives in that case. I still can’t bring myself to put yogurt in my vag. I don’t even like to eat it.

        • Bombshellrisa

          Evening primrose oil capsules too, although it’s just supposed to ripen the cervix, not “cure” anything

        • Wombat

          You can ‘paint’ (their words) your vagina/cervix/labia with gentian violet too. Added benefit of a ‘hands off’ signaling method y/y??

          “Not tonight dear, I’m purple”.

          • guest

            Ha! I knew of gentian violet for nipple yeast when breastfeeding, so I guess why not for vaginal yeast. Except, you know, purple stained underwear.

        • Melaniexxxx

          When I was a teenager and got a horrific yeast infection and didn’t want to tell my mother because I was freaked out by it… i googled this too.

          At the time ‘apple cider vinegar’ wasn’t really a trendy thing. I thought i could just ‘substitute’ it for regular vinegar.

          it probably doesn’t need to be said but the effects of pouring a low-grade acid on excoriated, inflamed vaginal and vulva tissue was NOT curative and NOT pleasant

          :O

          • Alcharisi

            Aiiiieeeeeee. That hurts just to think about!

        • MaineJen

          Lemon…juice 😮

          • guest

            It may have said to dilute it, but when I got to the words “lemon juice” my eyes rolled back so far in my head I couldn’t read the rest of the sentence.

        • Wubbsy

          Are those condiments or cures? Seems that a lot of them seem mostly intended to complement the smell of the yeast infection in a tasteful fashion, nothing more.

      • TheArtistFormerlyKnownAsYoya

        I’ve used yogurt, and far as I can tell, it worked. OTC yeast treatments are not cheap, and when you keep getting recurring infections, it can really add up. After 3 repeated infections I went the yogurt route, then didn’t have another for years. OTC treatments are around $20 where I am whereas yogurt only costs a couple bucks.

        • Wombat

          I don’t love OTC treatments for me, personally. Give me that little envelope with my 1 dose, please. But that requires me to have insurance and a current provider (yay America).

          I’m totally glad it worked, and I have seen others have it work. I see the theory. I just also see the sugar content in most yogurt (even unsweetened) and know that’s a very frequently cited reason not to put other stuff there. I suppose it’s a relatively low risk on the sugar only front: at worst you just get more yeast/don’t get better.

          I also see a lot of people claiming it’s been studied extensively (looking and only seeing oral or non-body/laboratory looks at probiotics) or is ‘proven’ to be better than Clotrimazole (1 study by a midwife). Finally, it’s not medically recommended anywhere I can find (which usually does it for me, but to each their own) and most who do recommend it are often doing so alongside guest’s post staples like borax and gentian violet. Thanks no thanks on those.

          But if we’re using supposedlies then there have also supposedly been cases of people getting sick from it, due to contamination (also having a hard time finding these, but there may be some shame factor there). Yogurt is certainly a lot more subject to manufacturing dalliances and especially transport. Most medications will be at worst rendered ineffective by heat at worst, vs something growing bacteria you don’t want.

          As a total aside, all of this ‘vagina yogurt’ googling has lead me to the PhD student who tried to make yogurt out of her vagina’s bacteria.
          http://www.huffingtonpost.com/2015/02/11/vagina-yogurt_n_6661792.html
          (original VICE source is linked there, but the terminology is a little more crude for anyone bothered)
          Although someone else doubts that’s what actually happened
          http://motherboard.vice.com/read/that-vagina-yogurt-probably-wasnt-really-vagina-yogurt-says-expert
          (Different VICE author)

          I think I’ll leave both the determination and the vaginal yogurt making up to them, personally.

          • TheArtistFormerlyKnownAsYoya

            It really was economic concerns that made me google “natural yeast infection cures” rather than any “big pharma” tinfoil hatness. I admit I had no clue about the sugar, or potential contamination concerns…might think twice before doing it again.

          • Wombat

            I totally get that.

            There was a while for me where it felt like I was getting UTIs way too frequently (I am more prone to them thanks to good ol’ anatomy, but those triggers weren’t really present) and I got pretty desperate in there. Especially since I didn’t reaaalllly have a current provider and the one I would’ve ‘made do’ to go back to probably would have just treated the one incidence at a time vs. addressing the overall problem. He was just kind of overly old-school that way. Great for some stuff, lot less so for others.
            Plus affordability was already why I didn’t have a super current provider. And I live on the edge of the South (currently embracing our status as such, unfortunately) so clinics or anything similar were in short or non-existent supply.
            I forget what I even did but I know I googled (capital G search back then, heh) similarly, it’s been a while. I may have just played the ‘hope’ card and gotten lucky that it actually ran it’s course, as ghastly to most of the developed world as that is. Depression, finances, college, access = self care in the toilet.

            Major agree on L’s point about doctors needing to step up their game when situations call for it. Not every woman has the time or means to come back each time. It doesn’t need to be first line but it should be more considered. I too was convinced I was colonized at one point because stuff just -would not- go away and kept showing up in different spots (with me taking all the proper precautions to avoid that). It was likely just stress being a disposition + hot ass summer not helping, but still aggravating. Aggressive oral treatment even if shorter course would have likely had better outcomes than the piecemeal I got and I would have been a lot happier at least trying it vs. ‘one more thing’.

            Barring the obvious one-time financial hurdle (that we ought not really have as a country) aggressive or proactive treatment might be a big help when things are miserably recorrucing as yours seem to have been. Then you could just have that 1 office visit/prescription and be done, with a lot less hassle and money in a more ideal universal or at least insurance situation.

            Essentially my line I walk is a mix of hopeful thinking that medical access could be a reality and trying not to hurt myself too badly. I’m sure I’ve fallen on the opposite side of that line more than once.

            So wayy too long paragraphs later (sorry) I just want to say I feel you, and sorry if my initial reaction/skepticism was a little over the top c:

          • guest

            I’ve had periods where I had chronic yeast infections, and no doctor ever did anything for me except say “yep, it’s a yeast infection. Use the over-the-counter creams and eat yogurt.” As a young college student at the campus health clinic, I was told there was nothing else to be done, it was an “environmental” problem and there was no other treatment (Diflucan was not available at this time). That’s a shitty thing to say to a woman who is getting a yeast infection *every* *month.* I ate the damn yogurt, but I think it was luck, or moving out of the dorms for the summer, that finally got them to stop happening so often.

          • TheArtistFormerlyKnownAsYoya

            Not over the top at all…these are things that absolutely should be considered. Unfortunately when you’re a broke student (or just sick of shelling out $20 a pop) you might not be in a position to do much else!

          • Heidi

            I’m not totally sure if I’m getting anything right on this, but I would think a plain, unsweetened yogurt would only have lactose as the sugar. And lactobacillus bacteria thrive on lactose, converting it to lactic acid. So I think that would be why it could work and may not worsen the situation.

          • Daleth

            Yes, exactly. Nobody is talking about putting strawberry Yoplait up your vag!

          • The Bofa on the Sofa

            Yeah, but you can’t trust the whackadoodles. Remember that when advising clients to use castor oil for inducing labor, midwives have to be clear that it is castor oil, not Castrol oil. Yep, they have to make sure they don’t drink motor oil.

            At that point, what’s a little strawberry Yoplait?

          • Wombat

            Sorry to hijack but while perhaps I’ve never delved deep enough into a ‘simple’ or organic brand, most I’ve seen have at least a little added sugar, like corn starch as a thickener (was looking for something totally different so mostly just a brief look at commercial brands via a grocery store). How much is hard to tell thanks to said lactose/the non-updated nutrition labels.

            Certainly much much better than using a sweetened yogurt, absolutely no argument there, but still.

          • guest

            I don’t know what yogurt was used in studies, but sites like the Mayo Clinic and the CDC seem to indicate that the studies don’t show much benefit from using yogurt vaginally, but they also didn’t show increased negative outcomes. It seems harmless at worst. Certainly, it’s cold and would be soothing for that reason if no other. (I like to apply an ice pack over pajama bottoms, personally.)

          • Heidi

            Just checked the Fage 2% Greek yogurt we keep for baby. Just milk and cultures. Of course, Greek yogurt doesn’t need to be thickened since it’s strained.

    • L.

      A lot of women turn to “natural” remedies for yeast infections because gynecologists don’t treat them aggressively. I had recurrent yeast infections and the gynecologists I went to would write me a prescription for a single hundred milligram fluconazole and say to come back for another appointment in a few weeks if the infection didn’t clear up. The gynecologists wouldn’t write a prescription for anything stronger or longer because they said it had side effects.

      I had a yeast infection under my clitoral hood for TWO YEARS because of this. What cured it was when I got a fungal infection in my toenails. My podiatrist gave me nine months of fluconazole (a hundred milligrams, three times a week). That had the “side effect” of finally curing my yeast infection.

      After that, I found a gynecologist who would prescribe a weekly fluconazole pill to keep the yeast infections from returning.

      • guest

        That too. I haven’t had diflucan yet, because the idea of waiting three days to get an appointment is unbearable.

      • yentavegan

        Going commando has reduced the occurrence/severity of my yeast infections. That and eliminating sugar from my diet.

        • L.

          What do you do about discharge though? Doesn’t it get all over your pants?

          • yentavegan

            I wear dresses with loose fitting bloomer style/harem style undergarments. the discharge kind of just …well no need to get graphic.

      • Rose Magdalene

        For some reason I’m very prone to fungal infections. The over the counter stuff no longer works for me, so when I get a yeast infection it means I have to see a doctor often multiple times to get it cleared up. It’s frustrating as hell and I’ve never found a medical practioner who’s willing to give me the hard core antifungals. So I’ve tried many of the natural cures. I’ve tried garlic, yogurt alone, yogurt with a tampon, several kinds of essential oils, I’ve bathed in apple cider vinegar, tried natural suppositories from the heath food store, drank large amounts of organic yogurt, taken pro biotics, drank coconut oil, put olive oil up there, and went on the cadida diet (that only lasted a few days). None of it ever worked. The garlic and the natural suppositories just made it worse. Yogurt would soothe it for a bit, but nothing more. I wouldn’t suggest treating topical fungal infections with garlic. I still have burn marks on my skin from that, and that was several years ago.

      • MaineJen

        The only time I was ever prescribed anything for yeast was when I was pregnant. Other times I’ve used the OTC stuff.

    • Dr Kitty

      PSA:
      Anyone with recurrent, prolonged or difficult to treat yeast infections needs to be tested for diabetes-preferably HBA1C blood test.

      People who avoid HCPS and are soaking tampons in yogurt and douching with chamomile tea might not be getting to the root cause of the issue.

      • Irène Delse

        That’s useful advice, thank you!

      • L.

        Yes, they should be tested for diabetes. However, when I had a yeast infection for TWO YEARS, gynecologists kept testing me for diabetes while under-prescribing fluconazole.

        Is there an underlying cause for my recurrent yeast infections? Maybe. But gynecologists never found it. They just kept doing the same thing while expecting a different result. Sadly, some of them also recommended the same folk remedies that are all over the Internet. Sometimes I sat on the exam table feeling as though the DOCTOR was reading an Internet message board to me. I’ve never felt that way at any other type of doctor.

        • Dr Kitty

          Eh…

          At least in the UK long term Fluconazole is unlicensed.
          I still prescribe it ( 1tablet every 3days for 3 doses and then once a week for six months) but I have the odd patient who objects to being “experimented on”.

          In the UK you can get oral Fluconazole as a single dose as well as Clotrimazole cream and pessaries free from pharmacies on the minor ailments scheme. Literally, you walk in, tell the pharmacist you have thrush and they give you free treatment.

          So if I see someone with thrush they’ve either tried and failed usual treatments, have the wrong diagnosis (BV, herpes, Chlamydia, cervical cancer, unexpected pregnancy – I’ve seen it all misdiagnosed as “thrush”) or have frequent recurrence.

        • mabelcruet

          Anecdotes don’t make good science, but a family member was referred to a specialist gynaecolgist and then to an immunologist because she had recurrent ‘thrush’ infections that didn’t respond to anything. After a load of tests, it was discovered that she was allergic to her husband’s sperm-it’s called seminal plasma hypersensitivity. According to the immunologist its supposed to be very rare, but he thought that it was massively under-diagnosed because it can mimic, and be mimicked by, other conditions.

          She has now remarried and has no problems with her new husband’s swimmers and no more thrush like symptoms.

          • Platos_Redhaired_Stepchild

            OT: Strangest and most painful allergy I ever heard about was someone who discovered their mucous membranes reacted badly to latex….when they lost their virginity.

      • Chant de la Mer

        Dr. Kitty I have an odd question to ask since you are a doc in the UK and you have different views on things. I did some looking on the internet and found cytolytic vaginosis but it also doesn’t look like it’s well known or acknowledged as being a real thing. So my question is do you know if this is a real thing or one of those woo things. I’m really hoping it’s real since it matches my symptoms and I’m really frustrated.
        Any other doctors that see this are free to chime in too, I’m just trying to figure out if its real before I see my doctor.

        PS I’m fat so I’ve been tested for diabetes 4xYear for the last 4 years and still no diabetes, lucky it’s a simple blood test and i’m not getting charged for it or I’d be pretty mad.

    • Alcharisi

      Is there a good reason why fluconazole isn’t available OTC in the US? Because it seems to work leagues better than any of the creams or inserts. I’ve gotten to the point where every time I see the gyno, I ask them to write me a prescription with several refills so I can just keep it stashed away against the inevitable.
      Honestly, though? The best thing I did for recurrent yeast infections (anecdata warning, YMMV, etc.) was to go on continuous cycling birth control. Having only four withdrawal bleeds a year (as opposed to twelve periods), and thus only having to keep foreign objects in my vagina that many times a year, led to significantly fewer yeast infections. Go figure.

      • guest

        No idea why it isn’t OTC. The day it becomes so I will let out a whoop of joy wherever I may be and do wild dance of joy.

  • Rita D. Lipshutz

    this one is brilliant, it reads like a manifesto for the science based medicine crowd. 🙂

  • Angela

    Spot on!

    I’ve said before that a sure fire way to get anti-vaxxers to turn into pro-vaxxers is for the majority of doctors and scientists to oppose them. Turn vaccines into something alternative instead of mainstream. Have scientists declare them dangerous and ineffective. Then, in defiance, the alternative health proponents will be lining up for vaccines.

    I really think this is the only way. Diseases making a comeback in large numbers, kids being disabled and killed, that won’t do it. Anti-vaxxers really just want to defy the experts.

    • swbarnes2

      Or, if there was some new technology that worked better than vaccines, and ordinary (even poor) people started getting that, then vaccines would be all “traditional” and they would be advertised as working with your body naturally, and then crunchy people would be clamoring for them.

  • Roadstergal

    Most excellent posts. It brings me back to The Wordy Shipmates, where Sarah Vowell talks about the Protestant “Read the book for yourself” ideals that turned into “Be suspicious of anyone who has studied to know anything.”

    • Bombshellrisa

      Yes! Umm, Sarah Vowell, Firefly and Red Dwarf. IRL we would probably get along swimmingly.

      • Who?

        Someone was looking for you the other day-maybe on the Kate whatsername post?

        • Bombshellrisa

          Me? Ok I will go look. Thanks.

      • Amy

        You’re a Browncoat too? Hi there! 🙂

  • Wombat

    What a timely post, given the despicable entitlement I just found myself exposed to.

    I was following the case where the Canadian homeopathic/herbal parents who killed their son via meningitis (I refuse to call it anything other than what it is) only got a few months each:
    http://www.cbc.ca/news/canada/calgary/meningitis-trial-verdict-1.3552941
    Start
    http://globalnews.ca/news/2783980/judge-to-sentence-alberta-parents-whose-son-died-from-meningitis/
    Sentencing
    http://www.calgarysun.com/2016/06/23/ezekiel-stephan-was-his-name
    Commendable (emotion-side) piece from a journalist

    And someone in a comments section mentioned a case currently at trial where parents refused to treat a diabetic child (also in Canada). The child literally wasted to death. So I checked for it. What I found instead – top result on my first search, Google apparently concurs – is currently a lesser kind of evil, but could easily end up just as ugly.

    http://www.livingwhole.org/to-the-parent-of-an-immunocompromised-child-who-thinks-my-kid-is-a-threat/#comment-107139
    ‘Enjoy’ the pseudoscience, casual racism (those damn dirty foreign tourists), and sanctimony that abounds. I already (semi)angry commented, which I (semi)regret. I’m sure I’ll be moderated, but it was liberating for me. My right regardless of her, apparently /sarc.

    Back to the diabetes case. Be warned, if you think you might be affected you may want to skip the second link. The photos the parents /happily/ took of their obviously wasting/dying child are not completely graphic, but they are still incredibly hard to look at without a lot of anger and sadness
    http://www.cbc.ca/news/canada/calgary/radita-alex-rodica-emil-citadel-diabetes-1.3596882
    Story (only healthy pictures)
    http://globalnews.ca/news/2723107/diabetes-expert-testimony-continues-in-murder-trial-of-calgary-parents-accused-of-not-treating-teen/
    Selected photos released from the trial, including household and Alex a few months before death. He is obviously starving but the latter complications that occurred (necrotic facial sores, etc) are not as visible (there are marks on his face that are surely what developed into them). Just for those who are unsure what they can handle.

    I need a shower. And then another 100. Perhaps a hammer and an icepick. Then I at least won’t be aware this ludicrousy continues to (and essentially continues to be allowed to, with sentences like the first – really, in some ways, worse) kill and maim children.

    • Stephanie Rotherham

      Jesus Christ, what is wrong with people?! I would happily sell my organs on the black market for money for my rabbit if she was sick, and a parent’s love is- or at least, should be- obviously stronger than that. Who could just sit and watch their child die like that?

      • Wombat

        Unfortunately, often extremer areas of religion (so Jesus Christ is often pretty apt). Which in many countries is what makes it hard to reign in before hand / prosecute after, on both ends of the government spectrum (theocracies vs republics/democracies).

        In the second death case the couple and the rest of the family are religious, but their church claims they took it further than they recommend/anyone else in the congregation does. Those statements, though, are of course after the fact. And there were possibly congregants viewing the boy before he died/there when the paramedics arrived.

        The first case is less directly about religion, more directly about supplements (they own a supplement company) but they’re absolutely religious as well. I think the driving traffic motivation is out the window enough to link the company’s About page, giving you some idea that they’re quite likely at least a little bit fundamental: http://www.truehope.com/the-truehope-story.html – also note the sickly ironic last option under the About header.

        Now I’m sure some people will say #NotAllFundamentals, but I’d argue that the ones who truly or vast majority avoid medicine and apply it to their children are just getting lucky /shrug. Not remotely my horse race outside of wanting enforcement/legislation.

        Many anti-vax people fall under that umbrella too. There are totally secular people as well, obviously, but even they tend to lean on out-and-out religious exemptions where looser ‘personal belief’ exemptions aren’t available – or where it’s more binding or convenient.

        And of course, there’s the argument that there are people who are just outright sick in the head. Not treatable but out of control mental illness, but something more evil or at least far far beyond the point of treatment/treatment willfully avoided even in times of relative sanity. Eugh.

    • Who?

      There are also a couple of Canadian cases where First Nations children with cancer were allowed by the Court to go for alternative therapies that their parents preferred to medicine.

      One of the children died, I believe the other is now undergoing medical treatment. Respectful Insolence wrote extensively about them at the time, these are a couple of the posts: http://scienceblogs.com/insolence/2016/05/06/wheatgrass-quack-brian-clement-returns-to-the-six-nations-scene-of-his-crime/
      http://scienceblogs.com/insolence/2016/01/18/makayla-saults-mother-racism-trust-and-science-based-medicine/

      • Wombat

        I will have to make myself read those. Just touching on the rest, though:

        There is absolutely some weight to what peoples out there looks somewhere other than traditional medicine (for example, the 2nd death case I mentioned – Alex – his parents are def immigrants and possibly Romani Pentecostals). For some, it’s more culture and for other’s it’s more fear, or somewhere a bit mixed and in-between.

        There needs to be accounting for that but I still feel like there has to be a balance with keeping children at a minimum level of safety. That doesn’t remotely even a little mean repeating mistakes of the past like AUS and other’s stolen generations, but it doesn’t mean feeding the kids to the wolves as it were.

        I think something like required governmentally supervised occasional medical visits are a decent balance. They can do whatever they want to or feel the need to in the meantime, they themselves can avoid care, and they can consent to the minimum of the doctor’s offerings for their child.. but there has to be something. And it has to be maintained (such as in Alex’s case where the parents moved and were allowed to be/remain ‘lost’ to the system) and ideally it would be closely so for situations where the child gets seriously ill and may need a higher bar for ‘bare minimum’.

        Not sure. It’s not an easy issue but that doesn’t mean I like deciding it on the backs of child size coffins any better.

        As a total aside, saddened to see frequently in these cases that Canada hasn’t escaped the US’s judge problem. Some variation in opinions is expected, but judicial finality cannot be and should not be at a level where there is such variance. Especially when much of it keeps putting lives at stake. Ugh. Too many dead children already today, and that’s just a toe’s dip in the pond, sadly. Haven’t even made it back around to the AIDs denialists’ kids, or the boy who died of VPD…

        • Who?

          It’s complicated, that’s for sure. For every nutjob parent who thinks wheatgrass juice cures cancer or garlic cures, well, anything, there are probably half a dozen chaotic, indigent or otherwise marginalised parents who can’t remember to put the milk in the fridge, assuming they have both milk and a fridge, let alone take the kids for appointments.

          One of the issues in the cases RI covered was that had the girls not been from First Nations families, there is no question that the Court would have made them wards of the State (or whatever the Canadian iteration is) and arranged for them to have the medical treatment recommended by the medical specialists. Another issue was that what the parents opted for was not ‘traditional’ to their communities. I tend to think the latter is a red herring-if we’re going to let the parents choose, then let them choose what they want. The former is very hard to accept.

          And then there’s this case, where ‘keeping the family together’ cost a child her life. Another judge who is perhaps wondering how to live with her decision.
          https://www.theguardian.com/uk-news/2016/jun/21/ben-butler-found-guilty-of-murdering-six-year-old-daughter-ellie

    • Wubbsy

      They are monumental idiots. There is a vast divide between refusing chemotherapy/radiation and/or radical cancer surgery (painful, high chance of not working) and refusing insulin for a child (healthful replacement of the product of a deficient bodily function.) Seems they fear medicine in general.

  • namaste863

    I dont know about you guys, but when I am sick and/or in pain, I want to feel better. And if I’m paying for something to make me feel better, it had damn well better get the job done. Ergo, I dont get why people waste their money on insanely overpriced crap that does absolutely nothing when there are perfectly good REAL medicines out there that have been scientifically proven to get the result I want it to get. Maybe it’s about proving that you have the disposable income to throw away on insanely overpriced crap and the paid sick leave to take when it does absolutely nothing?

    • AirPlant

      That is the horrible part, right? These remedies are mostly used on children. Their parents will chug Dayquil for the sniffles but snowflake gets peppermint oil on the feet because toxins.

      • demodocus

        part of that is that snowflakes under 6 aren’t supposed to use any cold/cough medicine.

        • Kelly

          That part is so hard. I have to convince my husband every time that one of my children have a cold that we can’t do much more than Tylenol. Their colds are never bad enough to take them to the doctor but it sucks to have to wait it out. We want to feel that we are helping them in some way.

          • Amy

            Same here. AND that if I do take them for something minor that I know they can’t/won’t treat, we’re out a co-pay just so that the medical expert can tell us that.

            He’s still yelling at me because I waited four days to see a doctor for my ear infection. Even though the triage nurse at my GP’s office told me to wait and see if it cleared up on its own before coming in.

          • Kelly

            If it makes you feel better, I think you did the right thing. You are not contributing to the rise of antibiotic resistance. I refuse to bring them in unless they stop eating or their breathing is starting to get bad. Since the only way I can tell if one of my children has a cold is by a running nose or cough, there is nothing a doctor can do for them. They eat well and are happy otherwise. Plus, I feel that when I come in all stressed out, my doctor will know right away that it is serious. Although, I do get afraid that I will not bring them in one time and it will be serious.

          • demodocus

            here too. We didn’t take our son in for colds until he developed croup around a year. He’d already had half a dozen colds (so much for that bf benefit.) Daughter has not yet caught her first, but she’s only 3 weeks old and its summer here.
            So hard to watch the little ones suffer the worstest thing that ever happened to them and basically you can’t do a dang thing about it. That’s why I stopped taking nyquil even when not pregnant or nursing.

        • Inmara

          And babies under 1 aren’t supposed to use any drops apart from saline water to help clear their nose a bit, so manufacturers of homeopathy are preying on that. When my baby got cold recently (second only in his lifetime, we’re lucky here), he had difficulties falling and staying asleep because his nose got congested all the time. I asked in pharmacy whether there is something to help, and she brought some drops “can be used from birth” which made me suspicious. Sure, homeopathy under fancy brand name! We resorted to Vibrocil which is supposed to be used from 12 months on, but I’m a firm believer of healing ability of good sleep, so we better get as much of it as possible!

    • LaMont

      Well there are a few reasons why people feel better I think. The first has to be the placebo effect. I know tons of people who swear by cranio-sacral therapy (including someone who TITHED to her therapist – she’s beyond hope, an astrologer/*empath*/grrrrrr) and I think they’re just psyching themselves into feeling better. Then there’s actual science-based stuff thrown in! I once saw a “homeopathic” remedy that ACTUALLY HAD the medicine in it, in measurable amounts. The real drug does the work, the “alternative” machine gets the credit! Surely there are plenty of therapies where the mechanism they claim is in play just isn’t, and they ride the coattails of the real thing all the way to the bank.

      Then there’s the fact that some people don’t want to feel better, they want to martyr themselves to the more natural, slower, more difficult recovery from whatever it is they’re dealing with.

      • Roadstergal

        Placebo effect – and regression to the mean. You take essential oil of whatever when your headache is the worst, and it gets better – because they generally do. You take herbal whatever for a week, and your cold goes away, because colds go away in a week.

        • Megan

          Like I tell patients: if I give you an antibiotic, your cold will go away in a week and if I don’t give an antibiotic it will go away in 7 days.

          • MI Dawn

            My grandfather, a GP, used to say for a cold “3 days coming, 3 days here, 3 days going”. Or he would say (if they insisted – similar to yours) – it’ll last 2 weeks if we don’t treat it and 14 days if we do.

        • Angharad

          There is an older lady I know who was recently in an accident. She says she didn’t realize how badly she was hurt until she saw her chiropractor. He told her that if she comes in for adjustments 4 times a week for three months she’ll feel all better. It’s going to run her $4000 and I am sick about it. I assume he chose three months because whatever injuries she actually sustained (hopefully just bumps and bruises?) would heal themselves within three months.

          • Box of Salt

            When I once was evaluated by a chiropracter (for free), I was told my mildly elevated blood pressure would go down after 3x week adjustments for 6 months.

            Meh. If I get my rear in gear and exercise enough to raise my heart rate as frequently as that same 3x per week, I can save both the money and time it takes it get to his office. And my BP went down after only the first week.

          • Who?

            I would be a wealthy woman today if I had no morals or ethics.

          • Bombshellrisa

            There is someone locally who is opening a “reiki studio” at $55 for an hour session. Can’t get to the studio? No problem, for $50 you can call in and have a distance session. I could make so much money being morally bankrupt.

          • MaineJen

            WTF. I just literally CAN’T with the reiki thing. It’s like…I’m not even gonna touch you. I’m just gonna put my hands near you. That’ll be $55. WTF???

          • Wubbsy

            Chiropractors have their uses. A good going-over can stop horribly painful back spasms in a manner comparable to a decent NSAID and muscle relaxant. To expect the cure for all from one is silly.

      • Bombshellrisa

        Not to mention that a lot of homeopathic tinctures have tons of alcohol. That has to have some effect : )

    • Kelly

      My Mom used both on my brother. He was severely handicapped and due to a very bad case of pneumonia, he ended up with some very bad lungs. My mom would use some kind of herbal supplement she found on the internet claiming that it worked. A few months later, it would be something else. My mom believes in anything that is too good to be true. She finally stopped telling me about her whatever new kick she was on because I started to counter her thinking. With my mom, it was wanting to believe that she could help my brother with these things and that she could control his symptoms. The good thing is that she also used medicine and doctors extensively but I wonder if all those supplements actually hurt him in the long run. We will never know but it is painful to watch someone you love spend a lot of their money on the new cure. I just have to ignore it or I get sick to my stomach.

  • Daleth

    Typo: the first “If it works” boldfaced line says “if *it’s* works.”

    • Amy Tuteur, MD

      Thanks!