I was planning to write a post on the subject of "alkaline water" this weekend but unfortunately a quick search on Pubmed did not turn up any good-quality study on human populations (I'm being polite here).
However, on googling I did find this blog which has been archiving the letters and articles on the subject.
I hope the author will continue to look at the claims of "alternative medicine" as they come into the limelight, and remind everyone: let the buyer beware.
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Dr Koh Lam Son used to be an MP. Alkaline water....
What is the pH of plasma/blood?
A friend, SLE sufferer swears by this type of nano technology alkaline water after consuming it for months. Her husband has a share in a factory located in Penang & plans to bottle the water & sell it through hospitals, pharmacy etc one day. Since the so called miracle water is being researched by a local university, its a wait & see.
As with all the expensive bottled water sold out there ie mountain, spring, distilled, oxygenated etc people will still buy it, don't you think so? If its your own health at stake, wouldn't you want to try out everything ?
"If its your own health at stake, wouldn't you want to try out everything ?"
No.
Dear angry doc,
I understand your stance against doctors endorsing any of these "non-evidence based" therapies.
Doctors have a certain system and standard by which they operate. It is fair enough.
But three points :
1) Many so called "evidence based therapies" that were widely used and prescribed by doctors later turned out to do MORE HARM than good. And they were subsequently withdrawn.
2) Some so called "non-evidence based therapies" later turned out to have "evidence based" benefits. For example Aspirin for IHD
3) When medical science tells someone there is "nothing more" they can do for him and the individual wants to try "for more" then it becomes a quest for hope.
It is one thing "not to encourage" these non-evidence based treatments, it is another to discourage their use.
I think unless there is proven HARM from taking the therapy there is little justification to discourage them. All of course within the financial means of the patient and of his own free will.
angrydoc, you may not understand how it feels to be waiting to die and not be able to do anything "more" than just listening to the doctor say there is "no other way". There is more to living than that.
1) Yes, and we know they do more harm than good because we collect and study the data - the decision to withdraw is based on evidence. When was the last time an "alternative" therapy was withdrawn?
2) Yes, except no good evidence for "alkaline water" has been published.
3) I am not in the business of *selling* hope.
"I think unless there is proven HARM from taking the therapy there is little justification to discourage them. All of course within the financial means of the patient and of his own free will."
That is exactly what people who sell you "treatment" based not on evidence but hope want you to believe.
Angry doc, I can feel your anger in your comments :( Put yourself in the shoes of patient with chronic illness or diseases, don't they deserve to HOPE something anything to feel better ?
"I am not in the business of
"selling" hope". Agreed HOPE is not for sale. If evidence based medicine do not work, what alternative do they have? Don't shut it out just yet.
"Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first. Wiliam Osler"
"Put yourself in the shoes of patient with chronic illness or diseases, don't they deserve to HOPE something anything to feel better ?"
What you or I think about whether or not they *deserve* to hope for is irrelevant to whether or not a mode of treatment works.
"If evidence based medicine do not work, what alternative do they have?"
Spending the time and money remaining doing things you enjoy with the people you love sounds like a good alternative, don't you think?
"Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first."
Osler was (as he often was) wrong.
In this day and age it is criminally negligent to base one's practice on what one sees instead of availing himself to the wealth of good-quality evidence that is out there.
tq Angry Doc. I'm a ca patient myself, survived 3 surgery the past 2yrs & during these roller coaster journey, I've seen Desperation with my own two eyes, one my late sis in law battling lung cancer with metastases to the brain, the other, late aunt with advanced stage uterus cancer. They tried both conventional + alternative in their battle. My brother in law puts in his own words "At least I know I gave her ALL, spent obscene kind of money to treat her illness coz in the end nobody can say I didn't try my best because I did"
Agreed, its better to spend Time & money with loved ones provided one is not bedridden, body wrecked in pain 24/7. Sorry just need to vent. Any other alternative means to stop breathing :D
"They tried both conventional + alternative in their battle."
And they both died.
I'm sorry if my heart doesn't bleed for you, but the fact is, everyone dies, and most people die of cancer or a heart attack or stroke. You are not the only person who has had relatives die of cancer - I too have my share.
Having cancer or having relatives who have cancer does not exempt one from facing the reality that most of the time, "alternative" treatment remain "alternative" because they are ineffective.
tq angry doc, I never expect sympathy from anyone & sharing my personal experience is from patient's perspective, what we hope for & if alternative helps even a little bit, fine.
no need to be sorry, your heart must be made of stone if it doesn't bleed. have a nice day anyway :D
I was very happy to see the letter on alkaline water in ST a couple of weeks ago and applaud you for also standing up for evidence-based medicine. Unfortunately the reply letter in ST was from H2O Lifesource, one of the major culprits bombarding our ears with radio ads for their product. They claimed the benefits of alkaline water are proven, but failed to provide any specific examples. As for your failure to find any major studies on PubMed, my guess is that the concept is so obviously" dead on arrival" that no one has found it worth the time and expense to perform studies, INCLUDING the alkaline water comapnies.
Nature journal recently published an editorial on the civic duties of scientists to speka up and educate others. Best regards to you, doc.
Dear angry doc,
When you say that you are not in the business of selling hope, you are in some ways correct.
However, as doctors we are "To cure sometimes, to relieve often, to comfort always." I think evidence based medicine or not, this phrase still holds true.
While you might not engage in selling hope, there is absolutely no benefit to the patient in aggressively discouraging them from hoping.
"Spending the time and money remaining doing things you enjoy with the people you love sounds like a good alternative, don't you think?"
The above is your opinion. Actually that is also my opinion on this matter too. However, these are our personal opinions. What right do we as doctors have to impose these opinions on them?
As I had said, it is up to the individual to decide what they want to do. As long as the alternative therapy has not been shown to cause HARM, there is little EVIDENCE for us to vehemently stop patients from trying them.
I am not trying to sell alternative therapies or hope therapies.
The point I am trying to make is that at some stage we have to realize that everyone has the freedom to choose how they want to live and how they want to die.
"To cure sometimes, to relieve often, to comfort always."
I don't subscribe to that loser-philosophy. We should always strive to cure AND relieve. Anyone can do the comforting part - you don't need to go to med school to do that, so don't pretend that you are a good doctor when all you can do is comfort.
"... everyone has the freedom to choose how they want to live and how they want to die."
You can *choose* how you want to die, but unfortunately you don't always get your choice.
You have the freedom to choose whatever type of treatment you want, but I likewise have the right (and obligation) to tell you that your wishful thinking is merely that.
Dear angrydoc,
Spoken like a true blue "House-style" doctor.
Arrogance. Know it all. Well House is a TV show. You unfortunately live in the real world.
Cheers.
"You unfortunately live in the real world."
We all unfortunately all live in the real world, where wishful thinking does not cure cancers.
By the way, you can always tell when someone is short on evidence in his claims - he uses words like "freedom", "rights", and "choice".
angrydoc,
I never claimed anything. As I said, I do not support alternative therapies. However I do think there is a difference between not selling and encouraging patients to try alternative therapies and outright ridiculing our patients' choices.
You have changed my friend. You are now so bitter. So so bitter. I feel sad for you. You must have experienced something that made you this way.
I am not sure you can call me your friend.
"...there is a difference between not selling and encouraging patients to try alternative therapies and outright ridiculing our patients' choices."
There is - I just don't see why we can't do both.
Patients are free to make their choices, but I don't see why their choices (or for that matter anyone's choice) when based on wishful thinking and not facts should be exempt from ridicule.
Besides, if patients and their relatives are happy with being able to exercise their right and freedom to make their own choice, why should the lack of encouragement or even ridicule from doctors they do not trust bother them?
Are you saying that your patients don't trust you?
Anyway I think you are missing my point.
You have obviously become somewhat disillusioned with some of your patients. I can totally understand where that comes from as patients in Singapore can be one kind.
This breakdown of trust and the relationship between doctor and patient is rampant in Singapore. Doctors ridicule patients. Doctors feel it is their right to ridicule them. Patients are angry with their doctors. Patients don't trust their doctors.
To feel angry to the point you want to ridicule shows that you still care. Just that there is a breaking point. You have passed that breaking point.
When I mentioned you don't live in a TV show, what I meant is that you do not have a CMB or CEO in your hospital who will be as kind to you as House's bosses are.
A doctor who ridicules his patients. I don't think that would be viewed too kindly by SMC either.
Take care my friend. Or well maybe you consider me your enemy. I feel really sad that you have become like that.
"Doctors feel it is their right to ridicule them."
Say rather that I think any person has the right to ridicule any idea - why shouldn't doctors have the right to ridicule their patients, and vice versa?
People shouldn't be immune from ridicule just because they are patients, just as people shouldn't automatically be trusted because they are doctors. We need to realise that whether or not you ridicule something or trust someone does not change the fundamental fact of whether something is true or false.
"Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic. Thomas Szasz, The Second Sin, 1973"
Late grandma a ca survivor of more than 40yrs, passed away 2yrs ago, aged 93yo gave this piece of advice "Do not trust doctor fully, for sometimes not all their medicine works, look at me I quit running to doc each time I have pain + aches, I outlive the early 'death sentence' doctors imposed on me'
Its also a FACT evidence based medicine sometimes 'drive' patients faster to the grave! Period.
"Its also a FACT evidence based medicine sometimes 'drive' patients faster to the grave!"
That must be why we are facing a silver tsunami...
I'm ashamed to have Angry Doc as a fellow colleague.
Why should you feel ashamed for someone else's beliefs?
You had nothing to do with me becoming a doctor, so you need neither to feel shame or pride for anything I may do, say, or think.
Be your own man.
dear angrydoc,
as a doctor, you are a professional. as a professional there is a certain manner in which you are expected to behave. whether you like it or not.
And ridiculing patients is not one of those behaviours that are acceptable.
Well of course you could say that as a doctor you are NOT A PROFESSIONAL. If you go that route then I have nothing more to say. But I can understand if you feel that way.
"whether you like it or not."
And as part of that professional body, I am challenging that thinking that patients should be immune to ridicule despite their beliefs simply because thay are patients.
I state my case here, and I invite my colleagues to re-think theirs too.
I am prepared to continue to tell my patients that their beliefs are wrong and that their thinking is illogical if that is indeed the case - even if it offends them, even if it makes them feel ridiculed, even if they feel that I am robbing them of their (false) hopes.
If "the profession" thinks I shouldn't state facts, then maybe it's not I who must change.
There is a difference between
"telling your patients that their beliefs are wrong and that their thinking is illogical if that is indeed the case even if it offends then, even if it makes them feel ridiculed"
and
"why shouldn't doctors have the right to ridicule their patients"
I am totally in support for the former but I don't think we should stoop so low as the latter.
"Stating the facts" is also different from
"Patients are free to make their choices, but I don't see why their choices (or for that matter anyone's choice) when based on wishful thinking and not facts should be exempt from ridicule."
The former is what the professional should rightly do and if in the process the patient is offended then so be it. The latter is the professional having intent to ridicule his patient because he feels it is his right to.
To paraphrase Eleanor Roosevelt, no one can be ridiculed unless he already feels that he is in the wrong.
"The latter is the professional having intent to ridicule his patient because he feels it is his right to."
There is also a difference between having the right to ridicule and having the intention to ridicule.
My point is whether doctors (or anyone) should not have the right to ridicule patients whose beliefs are wrong, or whether people who hold wrong beliefs should be exempt from ridicule merely because they are patients.
Do you ridicule people you like?
Do you like people who ridicule you?
Interesting quote you had there.
here are some too
“Ridicule is the tribute paid to the genius by the mediocrities.” Oscar Wilde
“Ridicule is the first and last argument of a fool” Charles Simmons
“First they ignore you. Then they laugh at you. Then they fight you. Then you win.” Ghandi
“Ridicule is generally made use of to laugh men out of virtue and good sense, by attacking everything praiseworthy in human life.” Joseph Addison
“Ridicule is the language of the devil” Thomas Carlyle
“Ridicule has historically proven itself a rickety fence for great ideas.” Vanna Bonta
"Mockery is the weapon of those who have no other." Hubert Pierlot
Seems to me the one who resorts to ridicule is the small one who maybe doesn't have enough "evidence". I do agree with you the evidence is there to debunk alternative therapies. But there is no need to resort to ridicule.
"Do you ridicule people you like?
Do you like people who ridicule you?"
I don't like people simply because they are my patients, and I don't need to be liked by my patients.
"Seems to me the one who resorts to ridicule is the small one who maybe doesn't have enough "evidence"."
Seems to me that those who feel ridiculed are those who know they have no evidence for their claims.
If you are a Forensic Pathologist, even your patients won't like you:(
We can all agree to disagree !
Oh yes, we can all agree to disagree, and sit happily by the fireside sipping a nice cup of tea.
That doesn't help anyone come up with better treatments.
So many commenters imply that it's ok to sell woo-based therapies just because it provides hope for the patients.
Well, hope doesn't cure.
I say that the sale of false hope is unethical. More than that, the sale of false hope undermines evidence-based medicine. Or evidence-based anything else for that matter. And undermining evidence-based medicine slows down our progress in doing things that actually improve the world. Undermining evidence-based medicine is even positively dangerous at times. Just look at the vaccine farce perpetuated by Jenny McCarthy and gang.
Angry doc, you have my respect. Keep up your fight against woo.
keep the fire burning angry doc keep being angry don't let the woo-mongers get you down.
hi angry doc,
"I don't subscribe to that loser-philosophy. We should always strive to cure AND relieve"
Regarding this comment, i feel that you should be a scientist instead of a doctor. You can then make more contributions to improve the quality of medical care. Leave the comforting and the ridicule to the doctors.
Hi, I'm not involved in the healthcare industry in anyway, but I just wanted to add that I tried this "Alkaline Water" before, out of curiosity. I did feel better both that day and the subsequent days after - though I suspect that it's because I almost never take in enough water anyway. plus there might be a placebo effect. however i'll still take that over the chlorinated water PUB gives us anyday
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