Is preventative medicine the same as alternative medicine?
Unlike preventive medicine, a more conventional medicine specialty, alternative medicine is not as supported by scientific and evidence-based studies. Watch preventive medicine expert David Katz, MD, explain the difference in these specialty areas.
Transcript
The other thing that preventative medicine has to be about is programs that affect the population. So in some sense, in preventative medicine,
the community is our patient. [MUSIC PLAYING]
I'm actually a board-certified specialist in preventative medicine. So there are standard medical boards in preventative medicine.
My training was a sequence of residencies, first in internal medicine, the general care of adults who get everything.
Heart disease, cancer, diabetes, et cetera. And then preventative medicine, where the focus really is on two things.
First, it's on identifying risk for disease in individual patients. So being really good at sizing up cardiac risk factors
or cancer risk factors and dealing more at the level of vulnerability and fixing it then so the fire
doesn't get started, then putting out the fire later, waiting for the disease and treating it. So we specialize in looking for vulnerability, fixing it early.
But the other thing that preventative medicine has to be about is programs that affect the population.
So in some sense, in preventive medicine, the community is our patient because very often the best way to prevent disease is to change an environment,
so people aren't exposed to tobacco, so that it's easier to eat well, it's easier to be physically active. Alternative medicine generally refers
to a whole set of clinical practices that are, in fact, alternative to or complementary to,
meaning they're done together with conventional medical practice. Now it's a blurry margin between the two. Conventional medical practice is conventional
because it is conventional. It's the stuff that doctors with MD after their name, or DO,
learn in medical school, practice in residency, and then do for the rest of their careers. It's also the stuff that populates
the pages of the major peer-reviewed journals. Everything that isn't there-- it's not taught in regular medical school,
it's not done in residency or in practice, it's not in those journals --is alternative. And I have studied alternative medicine extensively.
I don't just practice integrative medicine, which is the blending of the best of conventional and the best of alternative, but I've actually studied it.
And when you look at the evidence base, what you find is it's very variable for both conventional medicine and alternative medicine.
In other words, some of what's in alternative medicine is well supported by evidence, and some isn't.
I think what everybody who's ever going to be a patient needs to recognize is that there is baby and bathwater in both.
And we really have to be cautiously open minded. We have to be open-minded skeptics, open minded
so we have access to the full spectrum of treatment modalities that both conventional and alternative, or so-called integrative medicine, can provide.
But skeptical because, frankly, there is a fair amount of bunk in both, and there are always people out there just
trying to sell you something. One final point, from my perspective as both a clinician and a researcher,
one of the important issues with alternative medicine is not just that there may be less evidence there or that the evidence isn't quite as mature
but that there's a financial disincentive to generate the evidence in the first place. And the best single example of this is coenzyme Q10.
Coenzyme Q10 has now been proven effective in treating heart failure. It actually reduces mortality in heart failure by half.
But it took a decade longer than it should have to show that compared to pharmaceuticals because you can't patent coenzyme Q10, which is
a nutrient found in all plants. So the playing field of opportunity to generate evidence is not level, and that's why we can't rule out alternative medicine.
There's a lot of promising stuff there that just hasn't been studied adequately yet. Absence of evidence is not the same
as evidence of absent effects. So open-minded skepticism about all of medicine is the best way to go.
alternative medicine
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