Blog | Monday, September 19, 2011

"At least it can't hurt"


One of the things that constantly amuses me is how frequently I hear from patients that their other doctor told them there was nothing wrong with them using this or that home remedy or so-called natural treatment or some other form of complementary or alternative therapy, saying "Well, at least it can't hurt."

Coming from a medical professional, ostensibly having been educated in the scientific method and the value of randomized controlled studies, such remarks to me bespeaks a surprising degree of either naivete, lackadaisical attitude, denial, or an understandable wish to gain the patient's trust and not to take away the placebo value of the treatment that the patients feel to be helping them. In my more cynical moments I sometimes suspect that the other doctor is really trying to dismiss the patient's enthusiastic recitation of the vitamin or natural remedy that they are taking so they can get on with the office visit without undue delay.

The first thing that I find so surprising about this is that so few people imagine that something they believe capable of causing significant good would be capable of causing some harm or side effect. Patients are very quick to ask if me there are any possible side effects or risks to taking medications that I recommend, but they rarely ask if there could be any side effects to this or that vitamin or "colon cleanse" or "detoxifier." Frequently, they are under the misimpression that as long as something is "natural" that it must be safe. My late father-in-law, who was a family practitioner in Brooklyn, used to become incensed at that suggestion. "Why, cholera is natural!" he would exclaim. He knew whereof he spoke, as he had seen cholera epidemics firsthand in the ghettos of Poland. My family recalls fondly the shocked stares he drew when he expressed his outrage about this notion at the top of his lungs while shopping in the natural foods market in Berkeley California with my wife.

But the thing that I find most surprising is that so many of my colleagues do take it for granted that all of these complementary and alternative medications are probably safe simply because they regard them as placebos. It seems to me a matter of logical necessity that anything capable of having an effect may cause either good or bad effects or both. Yet when I point this out to my patients they usually respond with quizzical looks. Then some of the more thoughtful ones see the point. If I have the time I relate the story of my father-in-law and how "Cholera's natural!"

I'm not saying that complementary and alternative therapies don't work. I am seeing they usually do, but not necessarily in a positive fashion.

David M. Sack, MD, is a Fellow of the American College of Physicians. He attended Harvard and Johns Hopkins Medical School. He completed his residency at Lenox Hill Hospital in New York City and a gastroenterology fellowship at Beth Israel-Deaconess, which he completed in 1983. Since then he has practiced general gastroenterology at a small community hospital in Connecticut. This post originally appeared at his blog, Prescriptions, a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.