PA's and Complimentary/Preventative Medicine

[iaclg]

Hi everyone,

Here's my situation:  I've already been accepted to a PA program; however, lately I've been having cold feet about whether this career is for me.  I am a strong believer in evidence-based, natural and preventative medicine but am aware that my curriculum will be taught with the conventional style of medicine.  I have shadowed several physician assistants that I have seen give prescription after prescription, which might cover up the symptoms temporarily but may also not be addressing the root cause of them. While I realize not all PA's have this frequent prescription approach, I do fear that my curriculum will be teaching this style of practice as well. I should also note that I am however also aware and accepting that in many instances conventional medicine is the necessary route.  Therefore, I am not sure if PA is the right choice for me in terms of medical philosophies… are there commonly PA's working in integrative medicine, or practicing holistic evidence-based/preventative medicine? Thanks for any advice.

 

[rev ronin]

I practice complimentary medicine all the time.  When a patient has stopped smoking or lost a significant amount of weight, I try my best to notice, pause the visit to look them in the eye and say "good job". I think positive feedback is a good reward mechanism for many patients, and trivial to give out appropriately.

 

As far as complementary medicine, I tend to leave that to my patients' discretion.  I don't steer people away from things like chiropractic or acupuncture, and will often recommend them if PT or massage aren't helping.

[EMEDPA]

I'm a big fan of acupuncture. I like chiropractic for low back pain(where it has proven utility), but don't recommend it for other issues such as radicular neck pain where it can actually be harmful.

[Joelseff]

I practice complimentary medicine all the time. When a patient has stopped smoking or lost a significant amount of weight, I try my best to notice, pause the visit to look them in the eye and say "good job". I think positive feedback is a good reward mechanism for many patients, and trivial to give out appropriately.

Nyuk nyuk nyuk... Lol Rev. U crack me up sometimes...

 

 

 

 

Sent from my S5 Active...Like you care...

 

[JohnnyM2]

I completely agree with you iaclg. No doctor, or PA for that matter, has ever cured anyone. They just collect money prescibing drugs, scans, etc. Once when I was seriously ill in Africa, I went to see a witch doctor. And then the witch doctor, he told me what to do. He said: "Oo, ee, oo, ah, ah, ting, tang, wala, wala, bing bang." And, well you see, I am still here. Suggest you go to DO school and then Tibet for additional training. And don't let anyone tell you your ideas are a bit kookie.

 

[NLRP3]

Antibiotics cure people...

[NLRP3]

Acupuncture is the antithesis of evidence based medicine as well. Complementary and Alternative medicine does not have a corner on good preventative health measures. Those fall in the science based camp. Chiropracty? is a bit of a mixed bag, sure for some muscoloskeletal issues there is a mild evidence based, but alot of chiropractors believe all organic disease is attributable to subluxations (that cannot be detected on Xrays). 

[MedicinePower]

Acupuncture does have proven results, at least for chronic back pain and probably not due to meridian lines or energy issues. What's interesting is that these studies show it worked better than conventional therapy.

 

1)"CONCLUSIONS: Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy."

 

http://www.ncbi.nlm.nih.gov/pubmed/17893311

 

 

2)"CONCLUSIONS: Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects."

 

http://www.ncbi.nlm.nih.gov/pubmed/19433697

[EMEDPA]

Acupuncture does have proven results, at least for chronic back pain and probably not due to meridian lines or energy issues. What's interesting is that these studies show it worked better than conventional therapy.

 

1)"CONCLUSIONS: Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy."

 

http://www.ncbi.nlm.nih.gov/pubmed/17893311

 

 

2)"CONCLUSIONS: Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects."

 

http://www.ncbi.nlm.nih.gov/pubmed/19433697

agree. I wrote a paper last year on the scintific basis of acupuncture. There is some good evidence that it works for certain indications.

[discogenic]

Acupuncture is the antithesis of evidence based medicine as well. Complementary and Alternative medicine does not have a corner on good preventative health measures. Those fall in the science based camp. Chiropracty? is a bit of a mixed bag, sure for some muscoloskeletal issues there is a mild evidence based, but alot of chiropractors believe all organic disease is attributable to subluxations (that cannot be detected on Xrays). 

If we are to take your comments seriously, at least get the name right.

[rev ronin]

Just remember, not everything that is true is subject to placebo-controlled, double-blinded study.  Acupuncture may be one such intervention, but studies on exercise or breastfeeding can't ever rely on such techniques, either.

 

Evidence-based medicine is a spectrum, and all it can tell us is what is repeatable, for good or ill.  Things that aren't repeatable, or where variables cannot be controlled, aren't the antithesis of EBM... they're just outside its scope.  EBM does not have a corner on the market of medical truth.

 

True, there's a lot of nonsense, woo-woo, and snake oil out there.  It pains me to watch what's recommended to some of my Facebook friends by well-meaning peers, but at the same time there are things that start as anecdotes and end up being provable. I love being able to tell people that Vicks Vapo-Rub really does kill toenail fungus, for example.

[NLRP3]

I don't know if I can buy that EBM doesn't have a corner on medical truth. I mean isn't it the only ethical way to go? If we don't have evidence as the gold standard of recommendation, then what do we base our medical decision making on?  Why bother learning biochem, organic, pathophys if that is only a piece of the pie? I think we have an obligation to only back treatments for which there is sufficient evidence, because acupuncture is not without risks (infection and even pneumothorax). 

 

http://www.who.int/bulletin/volumes/88/12/10-076737/en/

 

And in response to those studies I don't think I would put those in the categories of "Good Evidence".  I know that for every positive study there is a negative one, but for the first study the dropout rate is >50%, which is a mark against it's validity. The second study is not properly controlled. Real acupuncture showed the same improvement rates as simulated (control). So if there is no difference from the control then it is an ineffective intervention. There was a shown improvement over usual care, but there was no control for time spent with a practitioner/counseling, both of which are shown to decrease perceived pain/increase satisfaction with care.

 

http://www.ncbi.nlm.nih.gov/pubmed/22169359 

 

Furthermore, there are a number of meta analysis which show that actual benefit is non-existent to low. 

 

http://annals.org/article.aspx?articleID=735061&atab=7

 

http://www.jclinepi.com/article/0895-4356(90)90020-P/abstract

 

 

 

If we are to take your comments seriously, at least get the name right.

How would you spell it? There are chiropractors who practice chiropractics? Plus you didn't respond to my criticism, you just insulted my spelling. I am hardly convinced. 

[rev ronin]

If EBM has the corner on truth, were treatments actually effective before being measured, or not?  Unless you're positing some sort of bizzaro "Schrodinger's Treatment" world where only after placebo-controlled RCTs does a treatment *become* effective or not, the answer is "No, the treatments were effective before, but we couldn't prove it",

 

EBM serves to ferret out effectiveness.  Thus, it doesn't have a corner on (or, if you prefer an exclusive claim to represent) truth, it's just one measure to test what is testable to see if it is an effective treatment or not.

 

No clue if this is you or not, but I'm a big fan of people actually having a well-rounded liberal arts education and not just a biology major with a chem minor before they approach medicine.  Gotta understand the philosophical underpinnings of what we do before we can ever hope to do it well.

[NLRP3]

I get where you are coming from. The quantification of an intervention is not what makes it in fact effective. However in the face of a highly improbable mechanism and a large body of negative evidence I think then we can say that something doesn't work. Furthermore the efficacy of treatments should at least have preliminary validation before they are endorsed by practitioners. That is the role of scientists and MD/PhDs. As individuals we are poor judges of efficacy, as we are very prone to a host of biases. The plural of anecdotes is not data, no matter how compelling the anecdotes are.

 

 

If EBM has the corner on truth, were treatments actually effective before being measured, or not?  Unless you're positing some sort of bizzaro "Schrodinger's Treatment" world where only after placebo-controlled RCTs does a treatment *become* effective or not, the answer is "No, the treatments were effective before, but we couldn't prove it",

 

EBM serves to ferret out effectiveness.  Thus, it doesn't have a corner on (or, if you prefer an exclusive claim to represent) truth, it's just one measure to test what is testable to see if it is an effective treatment or not.

 

No clue if this is you or not, but I'm a big fan of people actually having a well-rounded liberal arts education and not just a biology major with a chem minor before they approach medicine.  Gotta understand the philosophical underpinnings of what we do before we can ever hope to do it well.

 

Ok so you kind of have me pegged as a science nerd, but I read my fair share of philosophy and literature.

[Guest Paula]

An option is to become a PA and then go to naturopathy school. You would become Dr. PA and could find a practice with other like minded practitioners, some of whom will be MD/DO.

To the rest of us: stop prescribing the Z-pack for a 3 day cough, or for that matter a 10 day cough.

[PASASM92]

I haven't begun school yet, I start this summer. That being said, I am looking into the complementary and alternative medicine masters at Georgetown after I complete my MPAS in December 2017. Just food for thought.

 

I would simply like to know more evidence based practices that are considered in the US to be "alternative" to bring to a primary care practice.

 

 

Sent from my iPhone using Tapatalk

[discogenic]

It's worth remembering that the 'evidence' upon which we base EBM isn't always as solid as we'd like to think.

 

See John Ioannidis for example: http://www.vox.com/2015/2/16/8034143/john-ioannidis-interview (this is a lay interview/article, but if you're interested he has MANY scientific publications).

 

Ben Goldacre is another good source: http://www.badscience.net/

[zoopeda]

Mainstream western medicine is hellbent on finding Magic Bullets for disease and for reducing treatment variables (and therefore treatments themselves) down to the lowest common denominator, for the sake of "proving" a finding in a research culture that only rewards such reductionist pursuits.  There's no money in simply teaching people how to eat and live in healthier ways (in fact, there's even big money against it), and there's "no science" in "proving" more sophisticated treatment regimens that inherently tie in too many variables for a double blind study to handle.  As soon as antibiotics become obsolete, we'll be back to having very few, if any, pharmaceutical "cures" to disease--only symptom management and palliative care.  But what a PA training DOES afford its graduates is: the skill to be able to assess when such care is appropriate, the exposure to a large scale mainstream medical facility and patient population, and the ability to save a life.  Acupuncture and nutritional counseling and certain natural remedies absolutely have their place, and western medicine is sorely lacking a massive amount in the way of truly comprehensive care, but the status quo in the US saves lives and allows us to assess and stabilize the most severe of patients before implementing broader treatment.  I suppose it depends quite a bit on specialty as well, and where you want to work.  In my experience, many patients in the IM department are desperate for anything BUT pharmaceutical treatments, but surgery is going to offer less in the way of CAM therapies (although acupuncture pre and post-op has great promise, in my experience).  Patients are demanding results and better care; I think any PCP--be it an MD or a PA or an NP--has huge amounts to gain by combining a rigorous mainstream treatment with a CAM degree from a quality institution (be it an ND or DAOM, Midwife or Nutritionist).  2 cents, but I was told by multiple interviewers that my background in natural medicine was the biggest reason I was offered a bunch of interviews to PA school.  There's huge demand for integrative care; for good reason.  Good luck!!