More Meditation, Less Medication

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My practice motto is “More meditation, less medication”. This is a fundamental statement about how I approach medicine and patient care in general. As I was coming up through my medical training, I learned a great deal about testing and pharmacology while I was still in medical school. However, when I got to the clinical phase and started seeing patients in the hospital, I started to learn about something deeper which was called evidence-based medicine. We touched on this a little bit in medical school, however as I became an increasingly experienced clinician, Evidence Based Medicine (EBM) started to dominate how I learned to think about how I should approach testing and treatment. EBM looks hard at whether or not a treatment or medication, or test, actually does what it is supposed to do—and how well it does it.

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I started to notice that while we can say certain medicines work, what that really means is that for a small percentage of the people who take the medications there is some benefit. The absolutely most effective medication is placebo. In cases where no anatomic or striking physiological change is required, placebo works roughly 1/3 of the time. This means in cases like Zofran for nausea or medications for depression, the medication has to work better than the placebo to actually be considered effective. One of the craziest things about EBM is that the placebo effect has actually become more effective over time. Medications that were previously considered effective, when now compared to placebo, have the same benefit as placebo. Essentially, as we have turned more and more to medications to treat problems, the general public has started believing more their efficacy and so their own natural healing mechanism seem to work “better”.

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What about medications that are known to have a benefit; how beneficial are they? Well, one of the most studied medications, aspirin, has been shown to benefit one in 50 people who take it after having a heart attack. This means that if you’ve already had a heart attack, and you take aspirin, you have a 2% chance of avoiding your next heart attack or stroke. That is called the number needed to treat or NN T. The NNT for aspirin is 50. One of the most effective treatments with an NN T of 1.1 is triple antibiotic therapy for H. pylori. This means for every 11 people given the treatment, 10 benefit. That is a of a very effective medication regimen. However, the other side of a number needed to treat is a number needed to harm, (NNH). In general, we like to think that medications with numbers needed to treat of five or less are really good but, let’s say a medication has a number needed to treat of five but a number needed to harm of one. This means that for every five people you treat with the medication, five improved. Hey, Great! Right? Well, not so fast. That number needed to harm of one means that all five of those people you treated also experienced harms for the medication.

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The harms from medication can run everything from the benign, like a rash or itch all the way up to the severe, like death. For instance say you’re treating a rash with an oral medication that has a number needed to treat a five, which is good. However, the number needed to harm is 100 and the harm is death. Whoops! Not so good. In that case, the risks of the medication definitely outweigh the benefits.

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This is essentially how I think about medicine and medical treatment in general. I always think first about the risks and benefits of whatever I want to do. Does what I want to do for the patient have any harms? If so, are those potential harms worth the potential benefit? Obviously, the very best treatment would be a treatment within an NT of one and an NNH of infinity. Does a treatment like that exist? Probably not. However, there are lots of treatments that have a low NNT and no or close to no NNH.

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Second, I look at my patient’s own natural ability to heal themselves. For many things, we exist in a homeostasis and the body wants to return to that homeostasis. Essentially, most of my patients don’t really need me to do anything for them. The problem is that neither I, nor they, know ahead of time who actually needs my help and intervention and who doesn’t. After all, if you happen to be the one person whose additional heart attack or stroke would be prevented by aspirin, you probably want to be taking aspirin. One of those 50 people will be the one having the stroke we have to give it to all 50 people to hope to benefit that one. But, because the NNH of aspirin is 400 (harmful bleeds, usually in the brain), if I give the medication to 400 people hoping to benefit eight of them I am also probably going to harm one of them. Is the potential for harming one person to every eight I benefit worth it? As the brain bleeds tend to be less debilitating than the additional heart attack or stroke, we usually decide that, yes it is worth it.

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This is really the thinking behind my motto of “Less medication, more meditation”. Meditation is a treatment with many benefits, and essentially no harms. Meditation can have physiologic benefits like lowering blood pressure, lowering heart rate as well as reducing symptoms of chronic pain, depression and cancer. Meditation also has emotional benefits of increasing self-awareness; reducing stress, improving creativity, and helping people learn how to better manage conflict and anger.

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It’s not just meditation that I am a fan of. Other modalities that have either low or no risks include exercise, aroma therapy, improved diets, reducing intake of caffeine alcohol or tobacco. I am also a huge fan of cognitive behavioral therapy in conditions such as depression, anxiety and even difficult-to-treat conditions like schizophrenia, where cognitive behavioral therapy can aid the patient in managing symptoms. Often, just explaining a disease process or psychosocial cause of certain symptoms is sufficient to help people engage their own homeostatic mechanisms to improve their health. There is nothing magical about this; human beings have survived for over 200,000 years without the aid of physicians, surgery or medications.

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I didn’t pull any of these treatments out of a hat. I encourage my patients to engage in allied health practices because they are known to have benefits, and, I believe, help people engage their own natural healing mechanisms. People who have received Reiki treatments report sleeping better, and having reduced pain as well as a general sense of well-being. As Reiki does no harm, the psychological benefits alone are worth taking the time to experience it. Many things that we now know to be effective in Western medicine were once thought to be quackery. Just because we don’t understand why something works doesn’t mean that it doesn’t help. Perhaps, energy healing and chiropractic and all the other things that are included in Western medicine, really do just tap into the placebo effect. If so, great! If my patients are helped, I am happy.

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Ultimately, as a clinician, I think it is extremely important to understand that I do not have all of the answers. One of the things I frequently tell my patients, who are doing well on medications or a regimen I might not have chosen to prescribe for them, is that I have another motto, “If it ain’t broke, don’t fix it.” Although as a general rule medicine is not known for its humility, I have learned to take a humble approach to healing. I believe that the greatest healing strength in a physician is in the relationship with the patient. I also believe that the greatest healing potential lies with the patient, not with me or with medicine in general. Although there are conditions that absolutely call for strong medical intervention, most conditions do not– and even those that do require the full cooperation and intention of the patient to work.

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Medicine as we know it today, the insurance-based model, must change. It is impossible to have the kinds of in-depth conversations with patients needed to implement a true healing model in a 7 ½ minute conversation. I usually take 10 to 15 minutes in an appointment just to explain non-medication treatment modalities, particularly meditation. That is only possible because I can afford to give my patients 60 to 90 minutes on the first appointment, and 30 minutes, up to 60 minutes, after that as needed. People are complex, messy, and ultimately very much a product of their feelings, emotions and thoughts. That Western medicine generally ignores this fact about people is its greatest weakness. One of my favorite things about DPC is that I no longer have to.

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If you have any questions about evidence-based medicine, NNT or NNH, or meditation—or you want a referral to your closest DPC doctor—please call me at 760-425-4466 or email at DrEdwards@wowhealingcare.com. I look forward to hearing from you!