Cleansing alternative medicine courses from universities
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Cleansing alternative medicine courses from universities
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(this NEW Discussion on Doc2doc, was originally posted as BMJ Rapid response, dated 29 febr 2012-03-02, by Tjaard Hoogenraad; p robably a misunderstanding in posting has occurred.
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Cleansing alternative medicine courses from universities
posted at 7/3/2012 12:21 PM GMT
on bmj.com
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Posts: 24
First: 14/5/2009 Last: 7/4/2013 |
(this NEW Discussion on Doc2doc, was originally posted as BMJ Rapid response, dated 29 febr 2012-03-02, by Tjaard Hoogenraad; probably a misunderstanding in posting has occurred. Now I will try to post it online to BMJ once more but now by doc2doc) ========================================== SUBJECT Cleansing alternative medicine courses from universities may be worthwhile but we should not throw out the child with the bathwater BODY BMJ-Chief-editor Fiona Godlee, asked me to give my opinion on the issue of cleansing alternative medicine courses from universities. Columnist Ray Moynihan (BMJ 22 February 2012) wrote that he was not so sure that such a cleansing assault would be worthwhile because it could undermine campus conversations that could ultimately even enrich our scientific methods. At first blink, lets say intuitively (Ref.1) I had the feeling that alternative medicine courses should not be given on universities and that an assault to get them out would be worthwhile. For instance, throwing out courses on chelation therapy or acupuncture at universities seemed worthwhile to me. Chelation therapy is highly unscientific and dangerous and courses on unscientific dangerous treatments should not be given at medicine courses in universities and these institutes should aim at learning students how to make scientifically evidence based clinical decisions. At second thoughts, after some more critical thinking on pro’s and con’s of assaulting alternative medicine, I changed my opinion a bit and I tend now to agree with Ray Moynihan that we should not overdo the cleansing. Moynihan argued and reminded me that discussions on alternative medicine could even lead to an enrichment of scientific methods. I think he is right, although I hesitate to accept that campus conversations are the most appropriate place for induction of scientific enlightening or enrichment. I prefer that the discussions would be held online like in the online forum of BMJ-doc2doc or BMJ-rapid responses. In my experience these online BMJ discussions can be very enlightening. The pro’s of these BMJ moderated discussions are that they are relatively often patient oriented and not pharmaceutical industry oriented, that most discussants seen to adhere evidence based scientific methods (Ref.2). They are open for medical students and they go global and the discussions are coming everywhere in the world. In a doc2doc forum discussion with moderator Luisad (Ref.3) on unscientific use of supplements I agreed with her that we should not be messing around with mixtures of various vitamins and antioxidants but I also warned her that she should not throw out the child with the bathwater. Prescribing mixtures of antioxidant supplements is unscientific but conscientiously prescribing zinc supplements, 50 mg zinc per day, for prevention of deterioration in patients with Alzheimer’s disease is in accordance with the rules of evidence based medicine (Ref.4). Beware of cleansing unscientific medicine by wielding the sledgehammer or by throwing out all that you regard to be unscientific. You might throw out a precious attainment of evidence based, patient oriented, medicine. We should not throw out the child with the bathwater. Ref.1================================================ Critical thinking BMJ Rapid response: 10 may 2009 Editor Fiona Godlee asked: What is it about the process of diagnosis that eludes critical evaluation? In response I propose that it might be unconscious feelings, making part of the diagnostic process that elude such critical evaluation. In 1989 the Dutch neurologist Jos Snoek published the thesis entitled: “Het denken van de neuroloog” (The thinking of the neurologist). He had studied the the cognitive processes and diagnostic strategies of a series experienced and inexperienced neurologists. Snoek described that the diagnostic problem solving process could be divided in two types: an analytic type and an intuition-based non -analytic type. Experienced doctors have learned to rely on their feeling that the pattern they recognize leads to a right choice one although they have no complete argumentation for their choice. This type of feeling- based clinical thinking will largely elude critical evaluation. Pattern recognition is especially important for this intuition-based strategy. Intuition is a combination of knowledge, intellectual abilities and pattern recognition. Inexperienced doctors having not yet developed the abilities of an expert miss the feeling that they can rely on the results of their much more analytic way of problem solving. Thus, the diagnostic strategy in routine consultations seems to consist of two forms of clinical thinking: an “automatic”, quick, intuitive, non-analytic form and a much slower, analytic form of clinical reasoning that is used to solve difficult or unusual problems Ref.2 ========================================================================= No I am not a diabetes expert, I am a senior clinical study synthesizer Doc2doc posted at 31/7/2011 (in response to a message posted by doc2doc moderator Sabreena) No Sabreena, I am not a diabetes expert and if I were I would not know what it means: to be a diabetes expert. You write that you are looking for a senior doctor with diabetes expertise and probably you mean: with expertise in type 2 late onset diabetes mellitus. I feel sorry but I am not the man you are looking for: I am a Dutch senior doctor in neurology who developed only in the last few years scientific clinical interest in diabetes mellitus. I became interested when I discovered that type 2 sugar disease (= type 2 diabetes mellitus) and type 2 free-copper disease (= "type 2 Wilson's disease" = “free-copper -Alzheimer's disease”) have much more in common than I had realized before. Just imagine: type 2 diabetes mellitus and free-copper Alzheimer's disease seemed to have in common: not only extracellular amyloid plaques but also a disturbance in copper metabolism leading to increase of free-copper. Just imagine: free-copper toxicosis might play a causal role in degeneration of island cells in type 2 diabetes!. No Sabreena I think that I do not fit your bill, the more so because you are looking for someone who could fancy being the diabetes mellitus clinical champion for a year. Such a fancy is completely out of order for me. If you were looking for someone with expertise in helping young clinicians to learn how to synthesize evidence to improve clinical decision making in the treatment of patients with type 2 diabetes mellitus I would probably consider such a request. As long as I do not recieve such a request I go on fancying that BMJ-Chief-Editor Fiona Godlee will invite me to write a paper in the BMJ on critical thinking on cause and treatment of type 2 diabetes mellitus.Ref.3========================================================================= In Response to moderator Luisad: Do doctors take vitamin (or other) supplements? . (BMJ doc2doc Hoogenraad / 9-8-11) Luisad (doc2doc moderator) wrote that there is no evidence that supplements work and some evidence that they do harm and that in the latest Cochrane review was written that antioxidants may cause harm. She wrote that lots of intelligent people take them and she asked if any doctors we know take them. Well I know a doctor who takes every day antioxidatve zinc supplements. He takes 50 mg zinc/day in the form of zinc gluconate tablets. He is convinced that oral zinc is the best antioxidative supplement for prevention of Alzheimer's disease (see: bmj rapid response tjaard hoogenraad 3 aug 2011). He takes the dose of 50 mg elementary zinc because, in a placebo controlled clinical trial of zinc for age related macular degeneration, this relatively low dose was sufficient to induce a significant improvement of the vision. The supplement did work and did no harm! Luisad is right to warn for messing around with mixtures of various vitamines and antioxidants but she should not throw out the child with the bathwater. Anti-oxidatve zinc supplements should be evaluated just like any other medicine, that is by randomized clinical trials. Tjaard Hoogenraad, retired neurologist, UMC Utrecht; Neterlands ; see: youtube: video: Alzheimer zinc; go to: www.alzheimer-copper.com; Ref.4========================================================================= Breakthrough: Oral zinc for free copper toxicosis in Alzheimer's disease3 August 2011By Alzheimer's disease I mean: Late onset type 2 free copper dementiaand by Wilson's disease I mean juvenile type 1 free copper disease. My message: Synthesis of the best available clinical evidence leads to the hypotheses: 1. Free copper toxicosis is a causal factor in Alzheimer's disease2. Oral zinc is an effective and very safe treatment of free copper toxicosis3. Evidence based clinical decision: early signs of Alzheimer's disease: 50 mg elementary zinc/dayThis is the message I planned to present at occasion of the Alzheimer Association International Conference on Alzheimer Disease in Paris on July 19th,2011. I did not succeed to realize these plans. Therefore I placed an abstract of my paper on my website www.alzheimer-copper.com and I placed a short video on youtube: Zinc for Alzheimer. Tjaard Hoogenraad, retired neurologist, UMC Utrecht; Netherlands ; see: youtube: video: Alzheimer zinc; go to: www.alzheimer-copper.com; 0031 343 413519; tu.hoogenraad@planet.nl
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Re: Cleansing alternative medicine courses from universities
posted at 7/3/2012 2:45 PM GMT
on bmj.com
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*Moderator*
Posts: 1451
First: 7/4/2011 Last: 24/5/2013 |
Thanks for the post tjaard hoogenraad! We had a discussion along these lines recently: Should taxpayers fund universities that teach non evidence-based medicine? |
