My thoughts on medical research
By Jacob Mirman, MD
Medical Director. Life Medical
Life Medical is an integrative clinic. That means we use multiple modalities in treatment of our patients, both so called “conventional” ones and “alternative” or “complementary” ones. I use quotes around these terms because in my opinion the distinctions are strictly arbitrary, not defined by ethics or science. We use whatever modality we consider best for each patient’s case.
When people are critical of our integrative approach they often ask me how we choose the modalities we use on our patients and if they are evidence-based. It is human nature for people to want to see some research to prove the treatments actually work. And of course, they want the research to be in the form of large powerful studies, like those available for most conventional drugs.
Unfortunately, when it comes to complementary modalities such high level research is rarely available for several reasons. When I explain the lack of “good” research studies, some people smugly discount our work and brand us as quacks; if not out loud, then at least in their minds.
I have a problem with this “proper research” mentality and here is why:
Let’s first examine what “proper research” means and who can afford it. The “good” studies cost millions. Therefore, only large corporations invested in positive outcome of their research are able to carry them out. What about the conclusions of these studies? Can the results always be trusted? Apparently, the results reported are not always accurate. In his book Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients Dr. Ben Goldacre illustrates the multiple ways of how drug companies fudge data and manipulate study conclusions to make reliance on this research wholly impossible. He gives many examples of drugs supposedly shown to be safe and effective in these large studies that turned out to be neither. Some of the methods employed by these corporations have actually been criminal, causing thousands of deaths; the companies responsible have been fined millions of dollars. Not the greatest thing to feel smug about.
Good doctors know in their gut, that using drugs and other treatments based on this kind of research is fraught with problems. Many drugs get recalled or lose popularity following their use in practice for years because their dangers or lack of effectiveness become evident, so the good doctors usually wait a while after a new drug comes out, before prescribing it to their patients.
So what about the complementary/alternative methods? All the methods we use at Life Medical are evidence-based. However, our standard of evidence is different from conventional practices. We use whatever is safe and has been shown to be effective in our practice. We don’t have millions of dollars, and we don’t run large studies. Some new modalities occasionally come up and may seem to be useful. At that point we have to decide whether to include them in our patient care. This is how I do it, but this philosophy is different for other doctors.
Example: Magnet Therapy
One modality to illustrate my approach to evidence is magnet therapy. I’d heard about this method for years, but had not applied it in practice until my 75 year old father developed knee pain. He had a conventional workup done by an orthopedist that I referred him to. An MRI scan showed some erosion of the cartilage of the underside of his knee cap. He was diagnosed with chondromalacia patellae and offered arthroscopic surgery. By this time he’d had the pain for a month.
We had a family gathering around then, at which time my brother showed me some used hard drive magnets he’d bought on Ebay. These are very powerful neodymium quadripolar magnets (flat pieces with north and south poles present on each side of the plate). I put two and two together (excuse the pun, and be very careful if you want to put two of these magnets together: they can pinch your skin very hard causing a blood blister) and offered to tape one of these on my dad’s painful knee with some medical tape.
My dad’s knee improved and the pain completely resolved within a week. Once I see an improvement such as this one especially when I know that the treatment is safe, it becomes OK in my mind to use it in other people. My first experiments are always on myself or members of my family.
I bought a number of magnets on Ebay and started applying the magnet method into my clinic. I saw the magnets as very unlikely to cause any harm. This made them eligible for experimentation on patients. My initial run was around 20 patients. I was amazed to discover that a large proportion of these people improved. Joint pains of long duration resolved or greatly improved in around 70% of cases. The cost of the therapy billed to the patient directly was $5, fully refundable if it did not work. If these patients were to undergo conventional treatment, the expenses would be much much higher.
The first thing any provider should consider when using a new therapy is whether it is safe. Hippocratic Oath, i.e. First do no harm, is always in the back of my mind. Once I am satisfied it is safe, anything goes. This is not the conventional approach to research ethics, but it is mine.
I see many patients for musculo-skeletal issues like degenerative joint disease, sprains, strains, etc. We usually treat these people in our physical therapy department with both conventional physical therapy approaches and some really innovative ones, like Low Level Laser Therapy and others. Our LLLT underwent a vetting process similar to the one I used for the magnets before being included in our clinic.
Are magnets and Low Level Laser Therapy evidence-based therapies? Is my evidence of the successes on actual patients inferior to the large studies run by huge corporations with fancy impressive statistics? Given my experience, is it ethical not to offer this therapy to patients? I have my answers to these questions. Many conventional doctors don’t agree with my rationale, but I honestly I don’t understand why.
Most studies of unbranded treatments are too small to be strongly statistically significant or they don’t exist at all. Yet we pay attention to what’s available, select interesting candidates, make sure these methods are safe, evaluate their effectiveness in house and then employ them. This is how we approach most new therapies which are unlikely to be researched to the conventional medicine standard.
Our patients truly appreciate the range of our therapeutic offerings. Our approach provides patients with a wide variety of therapies which are often safer and more effective than the “properly researched” conventional methods. More often than not they are much less costly as well.
The American medical system is struggling badly and I believe that the current powers that be should take a good look at what we do at Life Medical. I believe that our approach can offer some ideas for the system as a whole. In my opinion some of our “alternative” methods should be “upgraded” to the “conventional” status. It may even save the system some money. I am ready to teach them any time.