When I speak with my less “crunchy” peers, I encounter a considerable amount of resistance to ideas that have initially gained traction in naturopathic or integrative spaces: food as medicine, making “non-toxic” swaps, meditation, or reiki, to name a few.
As humans, we certainly love a good us vs. them mentality, tribalism and all.
But the reality is, many of us have witnessed harm inflicted on patients who sought care in less traditional spaces. I still remember sitting at a case conference as a third-year medical student, learning about a baby who suffered a catastrophic stroke after a newborn chiropractic adjustment. Now, as an academic allergist/immunologist, it is not uncommon for me to see patients who have replaced a long list of pharmaceuticals with equally long (or longer) lists of vitamins and supplements in an attempt to rebalance or boost their immune system. Since neither approach worked, the patient was referred to me as a fifth opinion—a Hail Mary pass, so to speak—given my focus on using the increasing body of evidence supporting lifestyle medicine as part of my practice paradigm for managing misbehaving immune systems.
Theoretically, practicing evidence-based medicine (EBM) should eliminate the problems associated with anecdotal medicine, right? And yet, all too often, studies are flawed—too small, biased by funding, not focusing on patient-oriented outcomes. The population being studied often does not match the patients we want to apply the knowledge to. How frequently do the artificial conditions imposed on patients and physicians in studies deviate significantly from the realities of budgets, time, and energy in the real world? Or the cultural bias inherent in relying solely on EBM, ignoring the millennia of rich traditions found in non-Western cultures?
So, what are we left to do? We do the best we can with what we have. We assess the strength of the evidence and its limitations. We consider the potential harm of action or inaction. The possible benefits. We look at practicality and sustainability. And a question we ask a bit less often: What are our own biases?
When it comes to supplements, I am open with my patients about my biases. There is nothing quite like turning yellow and having a former intern turned hepatologist insert a big needle into your side to find out that the superfood supplement wasn’t so super after all. It is hard for me to completely set aside that bias, but I do my best.
During these conversations, I am often reminded of the saying, “Those who live in glass houses shouldn’t throw stones.” Harm occurs among our own: missed diagnoses, incorrect dosages or drugs, but even more insidious are the traumas associated with clinicians. It is easy to see how an adversarial visit or gaslighting could drive patients away from medical care, thus delaying diagnosis and treatment.
Sometimes, it is the language that, frankly, I wouldn’t have thought twice about until I found myself on the other side of the exam room—”You look fine to me,” “Labs are normal,” or “Do you think your weight/stress may be causing XX”—that, to someone on the diagnostic odyssey, feels like death by a million papercuts.
We are humans, not superheroes, not Gods. We all have our biases and view our practice of medicine through the lens of our personal experiences and education. We are also increasingly pushed to our own limits by the very dysfunctional system we attempt to function within, and hurt people hurt people.
At the end of the day, we all took that oath to do no harm. Perhaps we need to consider this oath from a more holistic vantage point, one that encompasses our own health, biases, and limitations as we redirect back towards that North Star of non-maleficence.
Kara Wada is a board-certified academic adult and pediatric allergy, immunology, and lifestyle medicine physician, Sjogren’s patient, certified life coach, TEDx speaker, and Dr. Midwest 2023. She can be reached at Dr. Kara Wada and on Instagram, YouTube, Facebook, and LinkedIn. She is a national expert, sought-after speaker, advisor, and host of the Becoming Immune Confident Podcast. She is CEO and founder, The Crunchy Allergist and the Demystifying Inflammation Summit, and serves as the director of clinical content for Aila Health.