Homeopathy, Alternative Medicine & Placebo | Med School Interviews

okay time for everyone's favorite homeopathy quackery and placebo a big juicy topic lots of medical school interview questions could center around the ethical and moral principles involved when dealing with treatments that have let's say a lacking evidence base behind them this is an area where you need to be able to leave your personal feelings at the door it's really easy to be reflexive and dismissive when answering these types of questions but in your interview you really can't afford to do that you need to be able to reason and work logically through these problems to solve them in a structured way and that's what we're going to talk about today firstly we're going to need to be able to define a few terms to help us make these points in a logically sound and coherent way the first thing we're going to talk about is alternative medicine what does alternative medicine mean well it's a bit of a catch-all umbrella term basically for any treatment that is not conventionally used by qualified healthcare professionals usually because they lack a supportive scientific evidence base for their efficacy and good examples of alternative medicines are systems such as chiropractic acupuncture crystal healing bone manipulation things like that a good example within that bracket is homeopathy it's worth looking at homeopathy as its own thing I think homeopathy is a system of alternative medicine that essentially uses very very tiny amounts of substances that in larger amounts would actually cause similar symptoms to the symptoms that the patient is experiencing with whatever illness they have essentially are using very small doses of what would in larger doses cause similar symptoms to the illness the patient has and finally the last thing we need to understand this placebo and what placebo is is basically when you're running a controlled trial to test whether or not a drug works one arm of the trial one group of patients will receive some sort of treatment that has an active effect so it could be a real surgery or a real tablet that has an ingredient in it that does something okay you're expecting that group to have some sort of physiological change the recibo group received a treatment that is in every way identical to what the first group receives but crucially it's missing that active ingredient that real intervention they will receive some intervention but you're expecting that intervention to do nothing if it was a pill for example the first group would receive a pill that had an active ingredient in it that we were expecting to induce some change the placebo group would receive a pill that was exactly the same in size taste color shape texture the packaging would be the same but crucially the placebo one would be missing the active ingredient and the reason you do this is so that when you're analyzing the data from your trial what you'd be hoping to see is that the group with the active ingredient responded to the change and it made some difference to the outcome but the placebo group had a very minimal or no change because you didn't include the active ingredient therefore you can say it was the active ingredient that made the difference because that's the only thing we changed I would also be really careful not to disregard the power of the placebo effect and just kind of dismiss it the placebo effect can be very powerful and have significant effects on outcomes it's been shown across a number of trials I think to adjust patients perception of pain if you give people dummy painkillers they will actually under report the pain that they experience there is actually such thing as a nocebo effect as well which centers around negative expectation of what a treatment is going to do if with the real drug you give the patient a list of the side-effects that that drug may have on them even if you give them a placebo it may actually induce some of the negative side effects of the real drug even though you haven't given them the real drug it's all the power of the mind it's really really interesting but in terms of what you guys are probably interested in in terms of your interview let's just work through a particular case let's say a patient comes in you're the doctor in the clinic they've got chronic back pain really common complaint in the Western world and they want you to give them this particular homeopathic treatment that they've been used to and they think it makes them feel better even though this treatment has no scientific evidence underpinning it right that's the situation the patient claims that the tablets that they're taking make them feel better even though there's no active ingredient in there as far as you can tell and this is actually a fantastic place where we can deploy the four pillars of medical ethics and use those to formulate our structure in working through the question if you've not seen my video I read the article on the four pillars of medical ethics now is a great time to stop this video go ahead and watch that one and then come back when you're done because we'll need them to move forward let's start with autonomy because it's maybe the easiest one to use the patient has their own freewill and can ultimately very much do whatever it is they want if they want to ignore everything you tell them completely and then go down to the corner shop and buy this homeopathic treatment from the person there you can physically do nothing to stop them that is their prerogative of course you also have your own autonomy as a medic and they've asked you to prescribe them this homeopathic treatment you can absolutely refuse to do that you don't have to prescribe anything to anyone you don't want to ultimately if they feel that the treatment is going to be a value to them that's up to them and that's their priority it's simply a capital value based exchange if they want to spend their own money on that product even though it doesn't do anything that's their choice of course I think things can get a bit more interesting when we're looking at the idea of beneficence that is acting in the patient's best interest and in this case your role is to advise and they're actually I think a few different angles you can take here the first being is that simply they're probably a waste of money if there's no active ingredient in and if you live in a particularly deprived area or the patient you know has complained about money problems before advising them that they are a waste of money and many of these sham medicines are expensive because of the nature of them then you can certainly tell them that it's probably not a good investment of their money the second I think more major concern is that if a patient engages with alternative medicine systems and they feel like they are working even when they're not the danger is that the patient may continue to seek these sorts of treatments instead of going after the conventional treatment that will actually help them with whatever their problem is and while probably in most cases this won't make a huge amount of difference if you're looking at something like chronic irritation these kinds of things can eventually lead to certain forms of cancer so it's over a long period of time but if a patient continuously doesn't engage with conventional treatments there could be very real health consequences for them further down the line and that's assuming it's only them if they feel like these things are helping them and they then go and tell all their friends that they're helping them and not to engage with proper treatments then you've obviously got a much larger scale problem and another thing to think about is that because these medicines have medicines don't actually do anything because they have no active ingredient a lot of the time they're not particularly well regulated because if they're not medicines they're not going to be regulated to the same standard but on the off chance that they do actually have something pharmacologically active in there it may interact with other medicines that the patient is taking and cause problems that way a good example to think about is something like st. John's wort right which is a herb or supplement that many people seem to take to treat mental illnesses or to help with their depression now I think the scientific evidence on this is a bit murky there may be something there there may not be but it's certainly not licensed as a as a medicine in these situations but since john's wort does actually interact with a whole load of other medications including the birth control pill beta blockers and statins in all of those cases it reduces the activity and efficacy of those other drugs which can obviously have massive consequences and we could actually flip this argument on its head and say what about if you as the doctor want to prescribe say a homeopathic treatment that doesn't have any evidence behind it there are a few positive arguments in this case the patient is not really in any danger arguably if there's a no active ingredient they may stop bugging you and you know stop taking up your time they may stop bugging you for antibiotics they might just leave you alone and go away feeling happy and ultimately we know that patients feeling P tends to lead to better health outcomes so why can't you just give them something that's going to make them happy even if you know it's useless but a problem comes in right because patients have to consent ultimately so any treatment they receive part of being able to consent and part of their consent being valid is that that patient is suitably informed about what the treatment is and what the consequences of it are if you essentially choose to deceive them by telling them that this tablet is going to do something when it isn't you are depriving them of information that would likely affect whether or not they chose to engage with the treatment and that is a big no-no in medical ethics this essentially means that they're not suitably informed to make that choice the responsibility would be with you as the doctor to give them that information so they cannot have given valid consent to that treatment and the whole situation then gets pretty dicey as far as you're concerned we've got two more pillars to go the next is non-maleficence and this is actually the one I found most difficult to come up with an example for but I've got one argument to put to you that is that because of the placebo effect we know that it can have both positive and negative effects right regardless of what the intervention actually is even if they receive a dummy treatment such as a dummy tablet or sham surgery or anything like that we know that the patient can experience outcomes as a result of simply having had an intervention and to me because that can have negative outcomes as per the nocebo effect even if you do the smallest of extra interventions beyond just your consultation that then provokes an opportunity for something negative to happen whether or not you think it will or you mean it - or not the fact that you've done anything at all invites an opportunity for negative consequences and therefore the potential for harm to come to your patient and as I said before this can either be directly to that patient that you're dealing with or someone else that they go off and then have a conversation with so you've got to be really careful and lastly from a justice standpoint in the UK everyone pays into the NHS a relative amount that's calculated for them and then they should in theory receive the same standard of treatment out of it I think that's fairly non-controversial but obviously there's a problem if you have one doctor in some isolated town somewhere that instead of prescribing conventional medicines that we know to work chooses to prescribe alternative treatments and recommend weird and wacky things that patient group is going to have worse health outcomes on average than groups that are treated with conventional medicines that's why we have clinical trials and so basically if within your practice you don't stick to the nice guidelines you don't prescribe the things you're supposed to prescribe and engage with these kind of unproven other health systems then that's going to cause problems both for you in terms of your professional accreditation probably and ultimately the patient's health outcomes it's a big no-no just do what the nice guidelines say patients are ultimately you know perfectly able to go and engage with these alternative health systems if they want but as a doctor you shouldn't really be engaging with them you should just advise patients of what the best course of action for them is in terms of their ideas their concerns their expectations and getting them as good a health outcome as possible so thanks for watching guys please be sure to hit that like button for me leave a comment subscribe to the channel don't forget to go and check out post-grad Medicom for more free videos and articles just like this you'll find the online article attach this video in the description below and you can go and find me on social media at post-grad medic on Facebook Twitter and Instagram thanks very much for watching take care and I'll see you next time bye

Channel: Dr Ollie Burton

Views: 11,631

Keywords: ollie, burton, ollie burton, warwick medical school, leamington spa, postgradmedic, medicine, medical school, med school, vlog, blog, ollieplays, ollieguitar, graduate entry medicine, university, education, diary, graduate medicine, grad medicine, grad entry medicine, study, revision, neuroscience, anatomy, physiology, placebo, clinical trials

Id: ULYXgMljU2E

Length: 12min 43sec (763 seconds)

Published: Wed Jan 16 2019