29 June 2021

Medical myths around us

Alexey Vodovozov: "It's silly to expect a positive therapeutic effect from chak-chak"

Kristina Ivanova, "Real Time"

"It's better for some people to breathe over potatoes than to run to the pharmacy and buy antibiotics," says Alexey Vodovozov, a scientific journalist, a therapist of the highest qualification category. Real Time provides a transcript of the second, "non-coronavirus" part of the open conversation "Myths, misconceptions and mistakes in Medicine", which Vodovozov held at the National Library of Tatarstan as part of the Milmax Science lecture hall. It tells about the horrors of traditional medicine, the tradition of bloodletting, standing on nails, finding "your" doctor, the placebo effect, homeopathy, dietary supplements, physiotherapy and much more.


"We have a lot of everything in current medicine came from folk medicine"

– What are the most ineffective folk medicine remedies?

– Folk medicine is a strange education in itself. We have medicine as a kind of field of knowledge. And absolutely everything that worked was left there in the end. We can now go to the bank of the Lower Boar and find a white willow there. We can pick its bark, make a decoction of it and then drink it at an elevated temperature. Will it be traditional medicine? On the one hand, yes. On the other hand, we can go to the pharmacy and buy aspirin. It will be the same, but much cleaner, dosed, without impurities. It was once a folk medicine. But then we found out that there are salicylates there, and they are not there in a completely suitable form for a person. We have chemically modified them a little, set up industrial production and now we know exactly what dose of the active substance is in the tablet, we know the side effects and positive effects. And, knowing all this perfectly, we use pure aspirin.

The same is true in all other areas. We have a lot of everything in current medicine came from folk medicine. For example, atropine. This is belladonna, a poisonous plant. But we, knowing its effect, have taken it from traditional medicine and are using it for the benefit of patients. Suitable sources that pass the test of time and scientific knowledge are deposited in the arsenal of normal medicine. But everything that doesn't work remains in the people's.

And some things from traditional medicine are of such a ritual nature. Yes, I understand that ritual things calm the parents of children first of all. And therefore I would not strongly criticize traditional medicine. Let them breathe over potatoes rather than run to the pharmacy and buy antibiotics. At the same time, we must remember that even with the same potatoes, we do not need to overdo it – we can get a burn of the upper respiratory tract, up to the trachea, people manage to burn it for themselves. And even in my childhood, mustard powder was supposedly a very effective remedy. In wool socks – and for the baby at night. Can you imagine what red and steamed legs are in the morning? There is already, in fact, a chemical burn. There were generally absolutely brutal folk methods of treating worms – and peeled garlic from the back of the intestinal tract, and other nightmarish things.

But there is also a positive grain in it. For example, is gargling a traditional medicine or a regular one? This is ordinary medicine, a normal approach. And what exactly to rinse, conventional medicine does not matter. It is the process itself that makes sense. But what we added to the rinse is already shades of traditional medicine. You can rinse with chamomile, you can calendula, you can eucalyptus. And these nuances of traditional medicine do not interfere with traditional medicine and correspond to scientific knowledge. It also seems to a person that he is being realized as a doctor for his household. But he does not go to the pharmacy for heavy drugs. So some things in folk medicine are useful: they have become entrenched and are still used. But, of course, it is necessary without fanaticism – without any invasive things, without caustic substances and other strange formations. There is no need for strange experiments on yourself and especially on children.

"There are people who quite reasonably use bloodletting"

– What is your attitude to hijama (bloodletting in Islam)?

– This is a thing that was fixed during the golden age of Islam – around the turn of the millennium. Back then, bloodletting was considered practically a panacea. Regardless of what happened to a person, what kind of disease he had, it was considered necessary to open his blood. From the point of view of modern medicine, there is some rational grain in this. But very small. Indeed, blood loss stimulates the work, including the hematopoietic organs. But not that much. The positive effect, to put it mildly, is greatly exaggerated.

Sometimes it is said that even during a hypertensive crisis, a person will feel better if they "dump" the excess "frozen" blood. This, of course, is not quite true. Blood can be frozen only because it is outside. As soon as we extract blood from a person, it coagulates, and quite quickly. This is the norm.

So the bloodletting procedure basically has a historical, traditional context. In the vast majority of cases, it will not hurt as much as it could. But there are serious conditions – sepsis, pneumonia, infectious hepatitis, immunodeficiency, when it simply cannot be used.

There are people who use it quite reasonably. And even religious figures with whom I had to communicate. They are well aware that any medical procedure has indications and contraindications. Not everyone can. But as everywhere, there are fanatics who are ready to apply absolutely any procedure (and it doesn't matter what it is – cleaning from worms, bloodletting or breathing over potatoes) in any situation, which, of course, is unacceptable.

"Finding your doctor is a big problem"

– In the last six months it has become fashionable to stand on nails. Allegedly, people go through fear, pain into a state when some kind of therapeutic processes take place inside. How does it help from the point of view of science? Is it possible for everyone to do this?

– This is a vivid illustration of the fact that the human body is an incredibly strong system. It is very difficult to move it out of balance. You can arrange interval fasting, walk on nails or hot coals, mock the body in every possible way, and it will tolerate all this. The compensatory capabilities of our body are simply incredible, especially at a young and middle age. This is if a person is busy and at least harms himself moderately, and not thoroughly. And he understands that we don't have any panaceas in principle.

We do not have any methods that would work at all on the entire spectrum of medical pathology: equally effective in oncological diseases, immunodeficiency, infectious, and ENT pathologies. That doesn't happen. Unfortunately, for all the time of the existence of science, it was not possible to find and prove, measure the life force. And, most likely, you should not count on it.

But very often the question is in psychological things. Some kind of pain syndrome eventually turns into a psychological problem rather than a physical one. And in remission, without acute manifestations, people find options for themselves how to cope with this chronic pain, to rebuild their perceiving system. And this becomes one of the options. Or there are people with increased suspiciousness who find absolutely all diseases in themselves. They may well do it, it will be like distracting therapy. But you need to understand that there is a very narrow range of applications. If we have a real problem, we will not solve it, and we can even make it worse. First we need to figure out if we have something really serious. If not, you can do at least Pilates, even Capoeira, even Tai chi, anything. The main thing is that it should be your pleasure.

You need to find your doctor anyway. This is a problem, it's not easy to do. Many have their own car mechanics, their own computer specialists, craftsmen who make nails, brows, and so on, whom we trust. So the doctor should be on their list. He does not necessarily have to be some kind of superprofessional in all areas. He can be something like a reference doctor: that is, you went to some specialist, then to the one you trust, and if he said that everything is fine, you continue to communicate with the first one. Our health is in our hands. And you need to handle it very carefully. Not only in private, but also in public clinics, I meet competent colleagues who prescribe adequate treatment, which mainly consisted of a couple of medications and lifestyle correction. If the list of prescriptions consists of 15-20 medications, then most likely you have gone somewhere wrong.

In addition, there are still problems with diagnostics. In medicine, the diagnostic and therapeutic parts are separated. And that's right – it's simply unrealistic to teach one doctor everything, so there are specialists. As many diagnostic doctors, there are so many opinions, often you have to choose something average and the most balanced.

"The placebo effect is still being studied"

– The question of the placebo effect. Is there any research on its effectiveness? For example, some claim that they give a child homeopathy and he stops crying…

– Some say: we give to animals, and they really get better. As you understand, it is difficult to objectify this matter. But when it comes to this, it turns out that the child reads, among other things, the mood of the parent. If the parent is anxious, if the mother is nervous, then the child can also cry. If mom gave him something and thinks it works, she calmed down, she got better, and the child considered this emotional state. If he was crying precisely because Mom was annoyed, it's possible that it coincided. He got better because Mom got better.

Small children often cry for a reason that is not entirely clear to us. They start crying and suddenly stop. Those cases when they stopped crying after a certain drug, we remember much better than if they stopped crying just like that. It is very common for us to look for a cause-and-effect relationship where there is none.

To tell how a placebo really works, clinical studies are conducted. For example, they gave this drug to a child and then they ask the parents what the child's condition is. And objectively assess the condition of the child. It turns out that these two estimates are sometimes radically different. Parents, for example, believe that it has become better, but the objective picture has not changed. And the parents felt that since they had done something, brought benefits to the child, he definitely got better. The placebo effect is still being studied...

"As soon as a certain phenomenon appeared, they immediately tried to attach it to treatment"

– How do you feel about homeopathy and dietary supplements?

– This is what is called parapharmaceuticals, and pharmacies make maximum revenue on this. I treat dietary supplements as what they are – as biologically active food additives. All. It's food. They are regulated by Rospotrebnadzor, not Roszdravnadzor. This topic is closed. This is the same as expecting positive therapeutic effects from carrots, chak-chak or something else like that. This is not a medicine, and this is specifically written on the package.

Homeopathy is more difficult. All over the world, scientific medicine is very strenuously disavowing this case. And pushes it into the private spectrum. For all the time of the existence of homeopathy, no evidence of effectiveness or at least hypothetical mechanisms of work has been found. Today, homeopathy is of historical interest. But otherwise, it is absolutely not an effective remedy. In medicine, among the medicines there are a huge number of drugs whose effectiveness is questionable or not proven.

– And physical therapy? In Russia, physiotherapy involves exposure to various magnets and so on. Does it work?

– What is called physical therapy abroad is like our physical therapy. These complexes came to the same Germany at the same time as us. But for some reason in the 90s we refused to do this. I don't really understand why, because there were a lot of good developments there. After the Great Patriotic War, rehabilitation work was on the shoulders of physiotherapists. Basically, it was not hardware treatment, but exercises aimed at rehabilitating a person.

About the devices… As soon as a certain phenomenon appeared, they immediately tried to attach it to treatment. Electricity appeared – they began to treat with electricity. Radiation was discovered – a boom immediately began. And cosmetics appeared with radium, and water was charged with radioactive elements, and they tried to be treated with radiation, including. Today something new appears – they immediately pick it up and try to be treated with it. But when the scientific base is pulled up, it turns out that this does not work.

I have an amazing personal experience. In the 90s, inspection trips of foreign military personnel to our army were common, they had to show everything, open hangars, things, etc. Our commander said to lose the keys to this, this and this hangar. Doctors also came to us. One day a colleague from America arrived, with whom we still communicate. He arrived with the rank of first lieutenant, and I was a senior lieutenant. We were equal in knowledge. He asked me to show him the infirmary, and we communicated in English. We come, he's like, "Show me something interesting." I decided to show the physiocabinet. He was surprised and said: "Do you have a museum of the history of medicine in every medical center of the regiment?" I say, "Yes, that's right." He took it that way. Of course, all this is interesting to study from the point of view of history – how people's attitude to certain processes used in medicine has changed. On the other hand, darsonval is fun. The hair stands on end, everything is wonderful, everything clicks. And it works on some people.

When a person simply requires therapy and requires to prescribe treatment for him, often in order not to give him heavy drugs, sometimes it is easier to send him to physiotherapy. Do not kick him out – otherwise he will go to the alternatives or to the pharmacy and buy what he wants. And if we send him to physical therapy, he will go there regularly, fulfill appointments. It will not be possible to immediately abandon this. There are a huge number of people who are focused on this. They expect this thing from the doctor. And if you don't prescribe it to them, you will be a bad doctor, and they will go looking for a good one, and he may end up on the dark side. So the question of physical therapy is not so simple. Yes, we understand that it doesn't work. But sometimes we prescribe for such purposes so that the patient does not go to the dark side.

"If there is an opportunity for a child to be born healthy, why not do it?"

– What is your view on the controversial issues of transhumanism or genetic modification? Without serious interference in the functionality of the human body, we will not be able to conquer galaxies and strive for Mars.

– Sometimes scientists, without realizing it, go beyond the line beyond which there are very few people. But there are restraining factors – ethics, legislation. But I am closer to that side: I understand that without this we will not be able to move forward. We need people who will show that this is possible. If we are going to conquer other worlds or sort out our own more or less normally, we really have to solve this problem.

Thanks to the achievements of medicine, children are being born today who should not have been born in principle. And why can't we make sure that they are born healthy initially? Even now there is a preimplantation genetic diagnosis, but only with IVF. We can already diagnose embryos and plant in the uterus only one that does not contain any defective genes. For some reason, they begin to say that this is eugenics. But that's not quite true. I understand that we are interfering in the process. But if there is an opportunity for a child to be born healthy, why not do it?

Apparently, this problem will have to be solved not at the level of scientists. Because they are ready for it, they can do it and it is the norm for them. This is how it happens – progress runs ahead, and ethics then catches up. It's never the other way around. Ethical issues also need to be addressed. Purely theoretically, artificial intelligence experts say that after a while they will be able to create a real artificial intelligence, one that will be a personality. Ethics immediately catch up and start asking: "Oh, it's interesting, and if you turn it on, you will have a moment of creation, you will create a new entity, it will be a personality. And you won't be able to turn it off again, it will be murder."

Another interesting question was asked to me in Kazan by children, high school students, during one of their visits. I talked about the medicine of the future and organs on a chip. These are, in fact, cells that are located on a huge number of biosensors. We can make a model of the lung, kidneys, liver, collect all this in a kind of information center. So, I was asked: "Is this device experiencing pain?" And I wondered. Because we can cause damage, we will have pain mediators, there will be the very molecules that carry them. Then it will get to the analyzing center with the blood flow. In fact, the pain signal will come to a certain model of the brain. It turns out that this device will experience pain. It will not report this. But everything about pain is already there inside. Is it ethical? There are also a lot of questions here. In any case, we come to the question of ethics. I hope that society will mature to this. I doubt that we will be able to move at the same pace in the same direction without genetic intervention.

The doctor chooses the lesser of his two evils: "I'll prescribe an antibiotic just in case"

– Why did the cult of antibiotics appear in Russia?

– Antibiotics are justified in many cases. Yes, I understand that we have a lot of appointments not on business. Moreover, interestingly, when the WHO considered this problem, it turned out that, for example, France is the leading country in unjustified prescribing of antibiotics by doctors, and Russia is self–designated. That is, our people just go to the pharmacy themselves and buy antibiotics.

What's the problem with doctors… There are different situations. And often doctors prescribe, as they say, just in case. If the acute respiratory viral infection develops into pneumonia, God forbid, with severe complications or a fatal outcome, the doctor's head will be unscrewed. If he prescribes an antibiotic, they won't do anything to him. This is not quite right, he should adhere to the standard of treatment, but this is the reality. Therefore, the doctor chooses the lesser of his two evils: "Just in case, I'll prescribe an antibiotic. I know that they don't work prophylactically, but if something happens then I just won't dismiss it."

Therefore, as I said earlier, we need a reference doctor who will say: "What are you! In your situation, an antibiotic is not needed at all." For example, with ARVI as a preventive measure, it does not work.

"There is nothing absolute in medicine at all"

– Are there more myths and misconceptions in medicine?

– They have always been there. This is a normal phenomenon. Now there are global information systems. And that's the only reason it seems to us that there are more of them. First, the speed of propagation has become higher. Secondly, a platform for self–expression was given to completely different people, including very strange ones, to put it mildly. Since most often they are sincerely confident in their rightness, they are charismatic, emotional, this information from them is perceived as true. Any person of science will always speak with reservations: under certain conditions, it may be possible, at the present stage so, and then it may change. And for some reason this is perceived as a weak position. Although it is just the right one. We cannot categorically say anything. There is nothing absolute in medicine at all.

Today there are about the same number of them, but they have more influence because they are in the global information space. Unfortunately, they even influence the decisions of politicians, including. And that's the scariest thing. When this story with "Hydroxychloroquine" (antimalarial agent) began last year and it was fed to absolutely everyone with coronavirus, it was an example of how an absolute misconception that resulted from a strange interpretation of a very weak study eventually reached the level of the decision of the heads of state. Medical information hygiene is extremely necessary.

– What about mothers, grandmothers who are engaged in the distribution of fakes?

– It's very difficult. They have a different value system in terms of information sources. The same TV, for example, is still a reliable source for them.

Usually such grandmothers are shown my YouTube shows on TV in a recording and say: "Here, please, look, the transfer. The doctor says everything is signed." Sometimes it works. Sometimes they slip my book – they still have an opinion that they won't print anyone. There are a lot of books by colleagues, a huge amount of everything in any direction. You can figure out what a person is interested in and show him the correct recordings on TV, but from YouTube, because they do not perceive the Internet, they do not consider it a source of information. Therefore, just show on TV or put the right books. There are also very elderly people who are beginning to be very actively interested in this and are moving to the bright side. But everything needs to be done gradually – this is an attempt on the worldview. If you try to pull it out right away, the person won't let you do it. And if gradually, slowly…

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