Is Preventative Medicine the Same as Alternative Medicine?

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I'm actually a board-certified specialist in preventive medicine. So, there are standard medical boards in preventive medicine. My training was a sequence of residencies, first is in internal medicine that the general care of adults who get everything heart disease, cancer, diabetes et cetera.

And then preventive 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 far it doesn't get started, then putting out the fire later, waiting for disease and treating it.

So, we specialize in looking for vulnerability and 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 preventative 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 two. Conventional medical practice is conventional because it is conventional.

It's the stuff that doctors with MD after they're named a D. O. learn in medical school practice in residency, and then do it for the rest of their careers. It's also the stuff that populates the pages of the major PR review 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 channels, is alternative.

And I have studied alternative medicine extensively. I don't just practice integrated medicine, which is the blending of the best of conventional, and the best of alternative, but actually studied, and when you look at the evidence phase, 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 in bath water 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 convention and alternative, or so called integrated 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 is both a clinician and a researcher. One of the issues with alternative medicine, it's not just that there maybe less evidence there, or that the evidence isn't quite as mature. But that there is a fine disinsentive to generate the evidence in the first place, and the best single example of this is Coenzyme Q10.

Coenzyme Q10 has now been proved ineffective in treating heart failure. Actually, it 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 nutrient found in all plants.

So, the plain field of opportunity to generate evidence is not lower 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 evidence of absent defects. So, open minded skepticism about all of medicine is the best way to go.