Pseudoscience / Science Criticism

Listen: Dr. Brian Goldman’s Soft Take on Alternative Medicine

Dr. Brian Goldman (@nightshiftmd), host of a great CBC radio show called White Coat Black Art that dares to pull back the curtain on the hidden world of medical practice, seems to be the latest victim of integrative medicine (IM). This IM movement has been gaining traction with Western physicians and medical institutions: many North American hospitals now include complementary and alternative treatments alongside evidence-based medicine. The world-famous Mayo Clinic in Rochester has done it; our own Jewish General Hospital has done it as well.

In a recent mini-podcast for the CBC show, Dr. Goldman was being interviewed on Dr. David Gorski and Dr. Steven Novella’s paper in Trends in Molecular Medicine entitled “Clinical trials of integrative medicine: testing whether magic works?”.  While he seemed to agree with the authors that treatments like homeopathy and Reiki have no plausible mechanism and have not been shown to work, my “hmm” alarm went off a few times when I noticed that Dr. Goldman kept saying, “the authors of the study show”, “the authors say”, “the authors claim”, etc.

At the end of the interview, Dr. Goldman, in a most irritating fashion, seemed to contradict himself:

“When there were calls in the past for more studies […], I thought it was plausible to wait and see. These days, I think, that attitude holds less and less appeal. I think anyone who is considering alternative medicine should ask tough questions about scientific evidence and, and I–I’d turn a 180 degrees if I don’t get good answers that this is safe and that it’s–it’s active, that it’s doing something beneficial.”

A few seconds later (italics mine):

“But if you are determined to use alternative treatments, then do them with Western medicine in addition–in a complementary way, not an ‘either/or’ thing. […] Be safe, do both, and hopefully you’ll find an enlightened family doctor or specialist who will entertain both.

You can listen to the whole interview here.

White Coat Black Art is one of my favourite podcasts. I think Dr. Goldman has shown remarkable drive and passion in bringing controversial topics in medicine to light. However, this is an instance where I think the IM movement is just too appealing. I don’t think physicians who “entertain both” are “enlightened”. I consulted with a Western physician a few years back when I wanted to “do both”, one last hurrah for wishful thinking before I became the staunch rationalist I would like to think I am today. This doctor did not agree to monitor my liver enzymes while I indulged in unproven Chinese herbs. He educated me and set me straight: he questioned my reasoning. That is being an “enlightened” physician.

Thank you, Dr. Tischkowitz. You did the right thing.

Dr. Goldman? How much negative evidence do you need to take a stronger stance? Enough of the wishy-washy stuff around alternative medicine. If it had been proved to work, it would be medicine. Let’s spend government money in more promising treatment modalities.

4 thoughts on “Listen: Dr. Brian Goldman’s Soft Take on Alternative Medicine

  1. I’m not sure how you can call Dr. Goldman the “latest victim of integrative medicine.” He’s clearly not in favor of integrative treatments.

    When Dr. Goldman said “Be safe, do both, and hopefully you’ll find an enlightened family doctor or specialist who will entertain both,” I think he was taking a shot at MDs who abandon patients, not endorsing alternative medicine. Abandoning a patient is an ethical violation and can result in harm to a patient.

    I think that Dr. Goldman advocating for a sort of harm reduction approach to alternative medicine: Using alternative medicine isn’t a great idea, but if you’re going to do it, you should be monitored by your primary healthcare provider and receive proper evidence-based treatment. It’s definitely better than abandoning a patient to fend for themselves.

    • Good point. I wasn’t advocating abandoning the patient. This sounds like a dichotomy: either the doctor follows the patient through his “integrative” care without saying a word or he or she abandons the patient. My point is that increased communication and education on the matter of evidence-based medicine is probably the best approach. This is what happened to me, and I’m glad my doctor took the time to discuss this with me rationally. I am aware that doctors in our public healthcare system are incredibly busy and educating the public on these matters is probably the last thing they want to add to their schedule. Given, however, how prevalent CAM is becoming and how welcoming of it medical institutions are starting to be, it may become necessary.

    • Most healthcare professionals try their best to educate patients, even if they are incredibly busy. Sometimes we get lucky and our advice resonates with patients, and we can convince them to stop using alternative treatments. However, there are patients that choose to continue with their alternative therapies in spite of the evidence (or lack thereof). They just strongly believe in their alternative treatments, and no amount of education is going to change their minds.

      Those are the patients that Dr. Goldman is speaking to when he says “Be safe, do both, and hopefully you’ll find an enlightened family doctor or specialist who will entertain both.” Those patients might not be basing their decisions on the best available evidence, but they still deserve to be seen by an evidence-based healthcare professional. Dropping those patients puts them in harm’s way, because now they haven’t got an evidence-based provider attending to them.

      It’s easy to demand a “strong stance” against alternative medicine from healthcare providers, but it’s impractical to implement it as a policy, and undeniably unethical if that strong stance involves dropping patients. The harm done by CAM becoming more prevalent is simply smaller than the harm that would come from dropping patients.

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