Click
here to printOut of Order: Gift horses
January 2012
SHARING OPTIONS:
I’m not sure why they asked me back—perhaps it has something
to do with the Mayan calendar—but I’m happy to share my thoughts with all and
sundry.
Truth be told, I’ve missed everyone—the ddn staff, of course, but also ddn’s
readers. I always enjoyed meeting you at conferences and hearing back from
you when I said something particularly inflammatory. At the risk of seriously
concerning Amy and the gang, I look forward to being inflammatory again.
A few weeks back, I read an interesting editorial in one of
the local newspapers. If I understood correctly, it seemed that the Ontario
Medical Association (OMA) was asking its members not to discuss non-Western
medicine with their patients—everything from traditional Chinese medicine (TCM)
to naturopathy, homeopathy to chiropractic—whether the member’s opinions were
positive or negative. The editorial was a decidedly vehement slam on this
policy by one of the OMA’s members.
From his perspective, the policy was tantamount to
practicing bad medicine, and given his tone, it seemed he felt it might have
bordered on Hippocratic heresy. To him, any effort to keep him from squashing
any patient’s interest in non-Western medical practices was the equivalent of
putting his patients directly in harm’s way.
In fairness, I should disclaim that I have been a patient of
TCM, naturopathy and chiropractic when I have felt that Western medicine has
failed to address my ailments, and feel that I have had success with some of
these practices. Much like the pharmaceutical and medical practices routinely
discussed in this news magazine, I have found these other practices largely hit
and miss.
That some Ontario medical practitioners questioned the value
of non-Western practices was not surprising. That there was such venom in the
response, however, did catch me off guard. And it got me wondering about the
black curtain that veils these methods.
A quick Google search for the phrase “outcomes-based medicine”
yields results in the tens of thousands. When you look at a lot of these
results, however, the focus is on scientific method and not, ironically, on
outcomes—which is the point of medicine, isn’t it? If you think about it, does
it really matter to the patient who is seeing no benefit from a given drug or
treatment that 72 percent of patients in a clinical trial did see a benefit
over the comparator? If the desired outcome is an improvement in the patient’s
disease symptoms (or even better, in his disease state), then I’d say no. This
patient is seeing no benefit from all of those (possibly) carefully crafted
clinical trials.
I’m not advocating that we totally throw caution to the
wind. But I don’t think we need to necessarily throw the non-Western baby out
with the non-FDA-approved bathwater. Many of these other practices have been
around for centuries, if not millennia, and have been sufficiently effective in
large enough patient populations to have lasted this long.
In the past, the pharmaceutical industry has figured out how
to make money from tree barks and saps, citrus mold and the delicate
complexions of milkmaids. Surely we can figure out how to take advantage of
this untapped knowledge—and unlike most natural products research, which has
seemed to me to be founded on pure serendipity (not that I have a problem with
serendipity), these areas of exploration have some real-world evidence to
support them.
Given the regular, seemingly cyclical challenges the
pharmaceutical industry has in coming up with the next generation of
blockbusters based on the last generation of blockbusters, or in redefining
blockbuster so that it refers to a drug that only significantly impacts
left-handed construction workers with the TBD2 allele, where is the harm in
throwing some of these tinctures and tablets into a little acetone and sloshing
them across an HPLC? Or in analyzing extracts against animal or in-vitro models of various human
diseases?
The only thing that’s keeping these centuries of anecdotal
data from becoming evidence-based medicine is … well, evidence. Rather than
disregard all of this information because it wasn’t officially sanctioned by
bodies like the FDA or wasn’t the result of carefully designed clinical trials,
maybe the first step in the screening process for potential new drugs should be
a simple question of what have the “neighbors” been doing for 400 years to deal
with a given condition.
There are no guarantees that any of this research would
amount to anything meaningful, let alone lucrative. But then, how much of the
work that is going on today comes with guarantees? Can we realistically expect
a 100-percent success rate from replacing a hydroxyl with a methyl group on the
3-carbon of a benzyl side chain of an antibiotic that stopped working last year?
Or the co-administration of an antiemetic with a new platinum-based oncology
drug to deal with a particularly onerous side effect?
I’m not advocating that we cease doing medicinal chemistry
or adjusting the clinical practice guidelines. I’m just saying that maybe we
should stop looking these potential gift horses in the mouth. To mix my
metaphors, they may be a red herring, but herring is a good omega-3 source.
Formerly the executive
editor of ddn, Willis has worked at both ends of the pharmaceutical industry,
from basic research to marketing, and has written about biomedical science for
almost two decades.
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