Dear Alternative Medicine – Stop Testing!

 

[HD: This post was also featured on KevinMD under the title, Advice for alternative medicine practitioners: Stay in your lane.]

Dear Alternative Medicine,

Hi, it’s HD again.  You may remember me from the last time we entered the squared circle, Endocrinology vs. Naturopathy – Steel Cage Death Match.  I had hoped that you might internalize a couple of the lessons I tried to teach you – “know your assay” and “know your pre-test probability” – but, shocker, it didn’t happen.  You regrouped and you’ve come back more formidable than ever.  In fact, I’ve noticed you’re refining your line of BS such that it’s getting more difficult for laypeople to distinguish between where good advice ends and quackery begins.

You’re telling people to eat, sleep, and exercise well.  You’re noting that good health is not simply the absence of disease.  Instead of simply focusing on an “illness plan” to address current symptomatology, you are creating a “wellness plan” with your clients to help them achieve their best health ever.  You’re…making sense!  So why am I getting my knickers in a twist?

It’s because you continue to couple your sensible advice with hundreds (sometimes thousands!) of dollars of dubious lab tests, all in the name of detecting imbalances, intolerances, and sensitivities. You have vitamin and mineral deficiency panels, gut microbiota assessment panels, autoimmune and inflammation panels, allergy panels, and toxic metals panels, all promising to reveal the reasons for your clients’ suffering (or simply point them in the direction of good health).  Unfortunately for your clients, many of those tests do nothing of the sort.  For instance, take one of your perennial favorites: IgG blood testing for food allergies (guaranteed to generate at least one positive result, or your money back!).  I’ve seen some of my patients advised to avoid milk, eggs, wheat, meat, chicken, nuts, and multiple fruits and vegetables.  Sure, they lose a few pounds over the course of the weeks they adhere to these draconian restrictions, but the constant analyzing of everything they consider putting in their mouths has them stressed to the max.  Speaking of stress, I’ve got another great idea for your business model – go ahead and run cortisol levels during this diet.  I’m sure they’ll be through the roof, which means another supplement to “manage” them.  Ka-ching!  You’re welcome.

Listen, I know it’s possible to test for all kinds of stuff in the blood.  But that doesn’t mean we should.  Just because there is a reference range given by the laboratory, it doesn’t mean that the range has been validated in a clinically meaningful way.  In addition, there are many blood tests that: don’t reflect tissue or cellular concentrations of the measured substance; have diurnal rhythms; have extreme moment-to-moment variability; represent recent dietary intake instead of reflecting stores within the body; represent simple exposure to a substance as opposed to an immune reaction against it…I think I’ve made my point.  Interpretation of lab tests is complicated enough without introducing scores of new tests that haven’t been extensively validated.

As an Endocrinologist, I would be remiss if I didn’t address hormones – one of the most egregiously misrepresented subjects by Alternative Medicine.  I recently heard a discussion of one alternative practitioner’s philosophy of “balancing hormones.”  This clinician describes how an anti-aging mentor approached hormone balancing by taking the mean at 25 years old, and a famous “Interventional Endocrinologist” I’ve never heard of took the median at 25.  But the provider being interviewed says, “I think it’s more like, take the 50th-75th percentile of ages 21-30.”  Ignoring the fact that this seems awfully arbitrary, are we actually shooting to achieve Lake Wobegon status, where everybody is above average?  I’m pretty sure that’s not statistically possible, but that’s beside the point.  This practitioner is checking hormone precursors and metabolites that have never been validated for use in a clinical setting.  Translation: mainstream Endocrinologists have no idea what to do with those numbers.  But this anti-aging expert knows: just push ’em higher.

Speaking of anti-aging experts, there’s really no polite way to say this (well, that’s not exactly true – I just don’t feel like it), so I’m just going to say it: the available “board certifications” in anti-aging are only a couple of notches above a google search when compared with a 2-3 year fellowship in Endocrinology.  While some boards have slightly higher standards than others, the basic requirements for certification are similar across organizations: have an MD/DO degree, demonstrate a commitment to the practice of anti-aging medicine, buy some course review material, attend a review course, and pass one or two exams.  I think it’s important to note that, when a doctor presents him- or herself as board certified, patients typically assume that the credential is backed by more than a textbook and a whole day of study.

So, Alternative Medicine, my advice to you is, stay in your lane.  By all means, counsel people to eat, sleep, exercise, and manage stress well.  But if your clients won’t internalize that advice, don’t validate their hope that they just need to get “balanced” through the right cocktail of vitamins, minerals, enzymes, probiotics, and hormones.  Too often, these people will spend thousands of dollars over the course of months to years, eventually winding up back at square one, in my office, telling me it must be their thyroid.  What a shame.

Yours sincerely,

HD

Image credit: Alex Wong on Unsplash

Do you think over-testing is a problem in medicine – alternative or mainstream?  How would you recommend we go about addressing this?  Comment below!

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8 Replies to “Dear Alternative Medicine – Stop Testing!”

  1. The gut microbiota assessments particularly gall me. It’s an emerging area of research, years and years away from clinical guidelines, but somehow supplement companies totally know how to “fix your gut” to “boost immunity” and “reverse disease!” There is a popular multilevel marketing scheme that is REALLY hammering this right now and it’s become like nails on a chalkboard to me.

    1. As a co-author of a systematic review on one mildly effective use for probiotics, I TOTALLY agree with you!!! I wish I had a dollar, or even a dime, for every client, interviewer, person at the gym…who’s asked me which probiotic to take for which condition. And every new mouse study just makes it worse!

  2. The whole anti-aging specialist trend is ridiculous. There is only one way to prevent aging, and that is to die young. No thanks. I think I’ll start a board certification in aging gracefully medicine and see if it catches on. Or maybe in living your life while you’re still alive medicine.

  3. I got into a twitter discussion last week regarding testing insulin insulin and glucose to calculate HOMA-ir. Which I’ve started to do but I’m not convinced it’s helping me. The other doc who I was chatting with mentioned he orders adiponectin levels and mentioned the lab that runs them. Darned if a rep from that lab doesn’t call my office a couple days later. I have no clue what adiponectin levels can tell me that a good tape waist circumference measurement can’t.

    1. Great points. 9/10 times, I know that someone is insulin resistant and I don’t need additional data to tell me that; the treatment is going to be the same. As for adiponectin, I can’t imagine ever needing that to guide therapy.

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