Before describing this week’s two cases, I want to point out the rather absurd strawman/false dichotomy presented during the show’s introduction
“Are prescription drugs always the answer or is modern medicine killing you?”
In reality, there would be very few doctors who would consider drugs are always the answer and I have yet to see a case on this programme of modern medicine killing anyone (or even coming close to it).
The cases this week were a patient suffering from sleep apnoea and another suffering from a reoccurring and painful rash.
As is fairly standard for the integrative doctors recommendations were made for the patients to improve their “diet, lifestyle, sleep” as well as “correcting imbalances”. The sleep apnoea sufferer was sent along to Buteyko (a type of breathing technique) once the doctor identified that his breathing technique was both rapid and unusual. Magnesium was also recommended to counter muscle twitching and melatonin to improve sleep quality. After a few months he was sleeping five hours a week instead of one, a major improvement, though given the multiple changes it is hard to know which change or combination of changes made the difference; the dietary changes, magnesium, melatonin and/or Buteyko. The TV producers also slipped in what seemed to be an unrelated plug for gluten free food, using a gluten free chocolate brownie as an example! (it may be gluten free but I don’t know about promoting fat and sugar rich foods?).
The rash sufferer had previously been diagnosed with shingles, however, a swab showed that it was instead herpes complex. Dr Pitsilis, after extensive questioning related this to stress and sent the patient along to a cognitive behaviour therapist to deal with the stress. After several months, her health had improved, though very little information was provided about the content of the cognitive therapy which might have been interesting. Also given she was also prescribed vitamin C, melatonin, micronised progesterone, magnesium and “stress” herbs it is impossible to know which of these may have assisted in her improvement. (again I will point out that progsterone is a drug).
For the third week running, the patients have been provided with advice regarding diet, given various supplements (including compounds classed as drugs) and thorough consultations have identified problems that I would expect most good GP’s should pick up. The treatments recommended also appear to sensible, given the symptoms.
One impression I did get was that both patients grew disenchanted with medicine after a poor initial experience with their doctors (including a misdiagnosis of the “shingles”). This should remind us all that it is important to be proactive as a patient and to get a second (or third) opinion if you aren’t satisfied with what a doctor is telling you.
Also despite the title, for the second week patients have been prescribed melatonin, and now progesterone, which by definition are drugs.
Interesting programme – yes
Pointing out weak points in our current medical system – yes
Showing that modern medicine is killing us – I don’t think so.
Excellent summary, Michael, with very little I can add. My supplemental points are from the view of a “mainstream” doctor with a cynical approach to journalism.
I recall being taught about Buteyko for sleep apnoea whilst at medical school (1980s, NZ). This isn’t “alternative” medicine, just old fashioned. I haven’t kept up with treatment for OSA, but I assume that Buteyko fell out of favour when F&P introduced high tech, high quality, low cost CPAP machines as an alternative.
As you say, the first patient had lifestyle changes, drugs (melatonin is now a prescription medicine) and the addition of breathing training. There’s nothing there outside of standard medical practice. A new doctor took the time to make a good evaluation, give good advice and an appropriate referral as well as some medication.
The main lesson to be gained from the rash sufferer is not to treat something that has not been diagnosed. The patient had six months of treatment for Herpes zoster (shingles) without first making sure of the diagnosis. That’s a lot of potential side effects without knowing there’s going to be a benefit. No wonder the patient grew disenchanted.
My own approach would have been to confirm the diagnosis (viral swab showed Herpes simplex, not zoster), then advise on lifestyle changes and refer for cognitive therapy. I wouldn’t have bothered with the drugs as they are unlikely to contribute and may do harm. And as for the herbal teas… a night time whisky would do as well if not better.
It was not mentioned in the program, but I suspect that the lifestyle modifications of the rash sufferer included smoking cessation. The patient had a particular facial fat distrubution highly suggestive of long term tobacco use. Smokers have several times the incidence of infections (all kinds) compared with non-smokers. Stopping smoking, without any other changes at all, would reduce the number of times the rash came back.
Again, almost entirely a standard medical approach to treatment. Take the time to get a good history, confirm the diagnosis, initiate standard treatment, the patient benefits.
The title for this episode could easily have been “Well Practiced Modern Medicine Benefits You.”