The other day I had suggested a physician give their patient chromium as a supplement to help even out their blood sugar. He said to me, “Chromium?! You’re going to have to give me some studies on that before I give them something like that!”
Immediately I said, “Sure, no problem.” So by the end of the day I presented him two studies from prestigious journals. One supporting my claim, and the other refuting it. Why not just load him with studies supporting my claim? Well first of all it kind of goes against the scientific method to do this. I couldn’t skew the thinking of the doctor with a bunch of studies hand picked by me to support my argument. The reason for the two studies was to force the doctor to read and critique both studies and decide why they came to the exact opposite conclusion. Whether or not the patient got the chromium in the end wasn’t really my goal, but rather to open their eyes to what scientific studies actually do for us - collect conclusions. The same doctor had recently expressed interest that omega 3’s and coenzyme q10 were worthless now because a study in England just concluded that they had zero benefit. Does one study prove anything? No. Does a duplicated second study prove anything? No.
In fact I knew if I kept digging I could probably present this doctor with a desk full of studies showing both results for chromium. My reasoning was to have the doctor understand that giving drug A to patient B to give result C as thousands of variables that were responsible for the results of that trial. Did the patient have water that day, were they Chinese, did they consume dairy, did they have arthritis, were they stressed out in traffic going to the trial, the variables are limitless.
Don’t get me wrong. The scientific method has brought us to the moon and back. There is nothing more valuable than a well designed placebo controlled, double blinded, cross-over trial with a large sample size randomly chosen. But what I am more interested in is “is the drug safe to take?” and secondly “is it effective most of the time?” I wanted the physician to realize that the drug was safe to use and that it might work in their patient. How many times did that doctor write for a medication that did not work for someone? They would argue that the science shows it works in the majority of patients - true; but it did not work in that patient. As far as that one patient feels, the drug was worthless and wasted their time and money.
There is no substitute for gathering and reading these studies on your own and making an informed professional decision - on your own. Not based on a position statement by a group that claims to be the expert opinion. At a recent presentation from PCCA, Sebastion said “How many studies are there to prove that parachutes work? or that you should drink water?” Zero. But yet people dive from 10,000 feet daily knowing they will probably be ok on the other end. Quite a feat knowing there are no scientific studies to prove their actions. Why spend millions of dollars a year on water when there really is no good placebo controlled, blinded, crossover trials with a good number of participants to prove that you even need it. You can argue that I feel terrible when I don’t drink water, but so does an alcoholic when they don’t have alcohol.
When I recommend a nutraceutical or hormone therapy or pain cream that I compound at my store, I run into the same wall - where are all of the studies. As it turns out there are studies available. However if I know it is safe to give in my professional opinion, and I will do no harm by giving it, then the physician will only become comfortable by using it one by one on their patients and evaluating it themselves. “I can get into trouble if it is not indicated officially though” is a common fear of the physician. I never once recommended in 20 years the drug gabapentin for pain (as it was not indicated for this use), but yet I sold enough on prescription to sink a ship!
As a professional we need to personally evaluate and critique studies and realize that an N of 1 is significant - if only to that one patient. Another physician once told me that they gave a new drug to someone who ended up in the hospital from an obscure side effect buried in the monograph that occurred only rarely. That physician now thinks of that side effect each time they write that drug and even write for different medications instead of it - all because of that N of 1.
Compounding pharmacies like ours and pharmacists that have faith in nutraceuticals to prevent and treat disease have these principles in mind each day. Scientific studies are tools to guide their decisions as a whole, not something to use as a deception to make your point.
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