A few months ago, I told you about a couple of poorly done Reiki studies. Without a positive example, it may have come across as judgy. I mean, Crones love to judge—we call it discernment. It is time for a Crone Journal Club on a well-done study about “Unconventional Medicine.”
You may be asking yourself, how do these Journal Clubs fit into the Crone vibe? Why do Crones care about medicine, especially “unconventional medicine?”
Well, lemme tell ya. Crones have historically been the keepers of knowledge, especially of healing. Well before “modern” evidence-based medicine we were the healers. The Cunning Folk. The Granny Women. The Curanderas. The Midwives.
Western “modern” medicine came of age in a very patriarchal age. Women were shut out of medical training. A side effect of this? Their accumulated knowledge was also shut out. In the early stages of modern medicine’s knowledge accumulation, data gathering, and deciding what was worthy of study, those with the “institutional memory” aka Crones were shut out. Much of the accumulated knowledge was disregarded because it was associated as feminine and therefore inferior.
Crones are still everywhere in healthcare. We are the grandmothers with the folk remedies, the patients deciding if we should use “unconventional” medicine, we are the “modern” doctors, the “unconventional” practitioners, the researchers. We now show-up in every area of health and shouldn’t blindly give allegiance anywhere.
If modern medicine didn’t start in such a gendered way, where would our understanding of medicine be now? We do know that in this “modern” age, patient of female physicians have lower patient mortality than patients of male physicians do….
History aside, the beauty of being a Crone is being able to stand outside of the world and look in to discern the truth. Many of us have finely tuned bullshit detectors for everyday life things. But, developing that bullshit detector when it comes to all things health is a skill we all can practice.
Let’s practice together so we don’t get fooled by ridiculous reiki studies or disregard well done information that may not jive with our preconceived biases.
I decided to review this particular article for my fellow Crones after a conversation with an integrative medicine physician. They told me about the article we will be discussing. It was published in 1993 and is considered the landmark article that started the field of Integrative Medicine.
What do I mean by Integrative Medicine? Let’s trace the names back through time to make sure we are all on the same page. Integrative Medicine←-Complementary and Alternative Medicine (CAM)←-Unconventional Medicine←-Folk Medicine.
Integrative Medicine is the field that is using the modern medicine lens of research and evidence to investigate what our grandmothers knew and validate it. They are finding some of it is BS (bloodletting—ok we knew that a long time ago), and some of it is well-supported (acupuncture).
So why is this the landmark study? Well, it was well done enough to be published in the New England Journal of Medicine (the most prestigious journal in medicine). It is framed as founding a new field of medicine. It exposed mainstream modern medicine to the reality that patients are using other modalities and that we should consider it and understand it.
So, what is this study?
Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993 Jan 28;328(4):246-52. doi: 10.1056/NEJM199301283280406. PMID: 8418405.
Let’s give you the TLDR of the study:
They performed a national survey of 1500+ people about use of 16 different types of “unconventional medicine” in the past year. Basically, about a third of people in 1990 in the US used “unconventional medicine.” Almost 90% of those people did not get recommendations for this from their doctors, and about 70% didn’t even tell their doctor they were doing it. Also, a comparable amount of money was spent on “unconventional medicine” and hospitalization out-of-pocket costs, and there were more “unconventional medicine” visits (425 million) than primary care visits (388 million).
These were mind-blowing stats. The extent of use was a major surprise to the medical world.
How did they do this study, and how do we know it is a good one?
Glad you asked!
When we start reading a research article we need to be able to clearly pick out what their research question(s) is/are. Hint—generally the last sentence of the introduction.
These authors asked: “What is the extent of use of unconventional therapy in the United States? How much is spent annually on these payments? What sociodemographic factors distinguish users of unconventional therapy from nonusers? For what medical conditions do people most commonly use unconventional therapy? And to what extent are medical doctors responsible for or informed about the use of unconventional therapy by their patients?” [put this in a quote block]
That is a lot of questions, but due to the nature of the study, it isn’t too excessive.
How did they try to answer this? This is the key to Crone discernment. We have to read the methods section to see if what they did makes sense. Luckily, these guys had their shit together.
They did a national phone survey with randomly generated numbers to hit the widest swath of people they could. They used statistics to calculate something called power (not Crone Power). Power means they determined how many people they needed to include to make sure that if they found a difference it would actually be statistically significant. A lot of surveys skip this step, and even if the numbers look significant, there aren’t enough people to truly mean it is.
They didn’t just include people in the survey willy-nilly to get to the 1500-person goal they calculated. They shared information on their exclusion criteria (aka who they didn’t include). They didn’t include people without phones, people who don’t speak English, and people who lacked the functional or cognitive abilities to answer questions. This seems reasonable enough to me, especially as they address how these criteria may have impacted their results later in the paper.
Not only do they tell us who they didn’t include, they also walk us through the exact number of people who couldn’t participate for every given reason. (Transparency, y’all).
They take us through their interview process. I don’t want to write the whole process out for you as it took up almost an entire page of the seven-page article.
Quick overview—they defined terms for everyone (ex. what is a doctor—MD/DO, what is an unconventional practitioner—everyone else). They asked about doctor visits, unconventional practitioner visits, medical problems and top 3 most bothersome to the individual, visits to all, money spent, etc.
You are probably on the edge of your seats—what are the 16 therapies? Here they are in order of use (highest to lowest prevalence)
Relaxation Techniques
Chiropractic
Massage
Imagery
Spiritual Healing
Commercial Weight Loss Programs
Lifestyle Diets (ie macrobiotics)
Herbal Medicine
Megavitamin Therapy
Self-Help Groups
Energy Healing
Biofeedback
Hypnosis
Homeopathy
Acupuncture
Folk Remedies
Their results that answer their research questions:
What is the extent of use of unconventional therapy in the United States?
34% of people
How much is spent annually on these payments?
$13.7 billion
What sociodemographic factors distinguish users of unconventional therapy from nonusers?
Age—most common 25-49
Race—less common among Blacks as compared to Whites, Hispanics, Asians, and Other
Education—more common with some college education than no college education
Income—more common in people with annual income >$35k (1990 dollars)
Region of US—more commonly used in the West
For what medical conditions do people most commonly use unconventional therapy?
Back problems, anxiety, headaches, chronic pain, cancer
And to what extent are medical doctors responsible for or informed about the use of unconventional therapy by their patients?
72% of users didn’t tell their doctors.
Doctors were most likely to be informed about homeopathy, megavitamin therapy, and self-help groups. were
Doctors were least likely to be informed about folk remedies, religious or spiritual healing, and imagery.
So what were other good things they did to make us more confident in the results they found?
They worked hard to show us that they had a population that truly represents the US. They shared their demographics with us so we can look and see for ourselves if we think the population is well represented. They compared the demographics of their study to two other large national surveys. It was similar to the population of the National health Interview Survey, but skewed healthier than the National Health and Nutrition Examination Survey. Not only did they try to validate with other populations, they were honest when one of them didn’t match, and hypothesized their healthier population may have underestimated “unconventional medicine” use. Makes sense to me.
They shared their limitations—many have to do with the people who could not participate as we discussed above.
You know one of the things that I like about the study—it ends by calling not just for more research, but also for more education of doctors about these therapies as well as how to ask their patients about the therapies.
And guess what? Yesterday I was teaching medical students how to take medication histories from their patients. We had long conversations about the importance of asking about nutraceuticals nonjudgmentally and their future curriculum will cover many of the therapies above, not to the level that they can practice them, but how to understand what their patients may be doing.
Today, I heard about a fellow Crone who had a “prescription” for mowing the yard and swimming from her doctor. The field is starting to adapt.
But back to the study—do you see the difference between how this study was done and how the Reiki studies were done? The methods and reporting were transparent. The statistics were robust. They did not claim more than their numbers could support and they admitted their weaknesses.
For those of you wanting to hone your medical BS detector (lord knows we need more people who can do this), please take a look at the study and walk through it.
What do you notice about this study that gives you clues that it is well done? My major pointers are: Did they clearly state what their question is AND give you an answer to the question? Were they transparent with their methods—who they included, how they did it, and how they ran their numbers? Did they report on all the data they collected? Did their conclusions fit and not overstate the importance of the data?
Remember being able to hone your BS detector in science is a crone skill. It always has been whether we were the ones slinging the herbs or reading the p-values.
The content on Crone Powers is for informational and entertainment purposes only. It does not constitute medical advice. I am a doctor, but I AM NOT YOUR DOCTOR. Always consult your medical and mental health professionals before ADDING—NEVER SUBSTITUTING—spiritual modalities to your care. Remember, woo only works when you do the work.
The views and opinions expressed here are my own and do not represent those of my employer or any institution with which I am affiliated.