Leeches are very helpful in microsurgery, such as delicate reconstructive surgery of the hand, face, any body part in which blood and fluid can accumulate at the operative site and must be kept drained so as to protect the integrity of the wound and not strain the sutures. I worked as a med/surg nurse in a teaching hospital once where a patient had fingers reattached after an accident. The order was to remove and replace the leeches at the site every 24 hours. You pull them off with a gauze, put them in a jar, and get another leech out of another jar with forceps and put it on. Pharmacy distributed the leeches and disposed of them. They were bred sterile without disease.
Maggots also have an increasing use in wound healing, partly due to antibiotic resistance. Maggots only eat dead flesh. The microbes causing the infection are resistant to all but the antibiotics with the worst side effects, like amphotericin. MRSA (methicillin resistant staph aureus), VRE (vancomycin resistant), &c are common today due to antibiotic overuse. Diabetics, those with chronic venous stasis ulcers of the legs, other circulatory problems, trauma, persistent pressure ulcers (bedsores), have chronic unhealing wounds which cost millions or billions a year in treatment, disability, lost productivity, &c. Some people are putting maggots in the wounds. They eat the dead flesh, clean it up, and promote healing, all without pharmaceuticals. They're natural and safe. These maggots are bred in a sterile environment. You just have to get past the squick factor. Personally, I'd prefer maggots to tons of antibiotics and painful dressing changes if I had an unhealing wound.
All drugs are originally from "natural" substances -- plants, &c. Their effects on humans were observed over the millenia by practitioners. Only recently have the sciences of chemistry and pharmacology developed sufficiently to recreate the natural substances in greater quantity, and to create new compounds. All drugs, from "natural" sources or made in a lab, have biological effects by virtue of the fact that they affect the nervous system and neurotransmitters in different ways -- they either enhance their natural action or they block it. The body does not know the difference between a "natural" drug or one from a lab. The difference between the two blurs and becomes meaningless when you think enough about it. There are many substances used in third world countries by native healers who still have their indigenous healing traditions which increasing numbers of anthropologists and now pharmaceutical companies are looking at in order to find new drugs.
Now, who these evidence based practitioners who observed the effects of substances on humans were is another matter. Barbara Ehrenreich and Deidre English's "Witches Midwives and Nurses:A History of Women Healers", among many others, convincingly talks about the historical social class and educational divide between the ordinary, peasant class people who did the actual evidence based healing in the community (barbers were the orignal surgeons, midwives and others were highly skilled practitioners who handed down their art by apprenticeship, not by written text or in universities) as opposed to university trained "doctors" who were immersed in the ridiculous theories of health and disease which we chuckle at today as being harmful and probably worse than the disease. Some think the peasant class healer was demonized and eradicated around the time of the Reformation and Enlightenment partly due to their prestige in the peasant communities and political resistance against land reform, closure of the commons, and other political struggles of the time.
In obstetrics, maybe 10% of what we do is evidence based. Only 10%. However the legal system drives OB practice and determines standard of care, not EBM. This is a huge topic in OB and midwifery and nursing professional circles. OBs are quitting delivering babies in droves all over the country and are dumping their collaborative practice with CNMs based on liability issues. This is becoming a public health issue. What can we do about it? Nothing in our current legal climate. Is EBM research being done in OB? Slowly but surely, such as studies coming out demonstrating the safety of homebirth, intermittent monitoring, TOLAC, &c, but old habits die hard and threat of lawsuits are real. American women do sue at the drop of a hat if they don't get their perfect baby. American woman actually DEMAND c-sections for no reason. Many docs cave in because these women will take their money elsewhere, and the doc can be charged with "abandonment" if he refuses to care for her, ie give her a section. Our system is such that the only way these people can get a "bad baby" provided for is to sue the provider, whose insurance will pay out millions in settlement, which is then placed in a trust to support the kid. I have heard that the burden of support is placed on the insurance industry because there is insufficient gov't support for disabled children. So our health care system is near meltdown, and this is one reason. It is not like this in other countries, such as England. OBs do inductions and c-sections with no evidence of their benefit, but the patient is tired of being pregnant, or the OB thinks the baby is macrosomic (large size, over 4000gms) and he fears birth complications such as shoulder dystocia (lawsuit) or failed labor leading to section anyway, but there exists evidence of the harm in doing these inductions in what turns out to be a "near term baby", necessitating higher NICU admissions and neonatal complications. Again, insufficient evidence based research, or the research is not used well enough in court to justify a clinical decision. The courts and lawyers dictate medical practice. HMOs and insurers tell MDs and CNMs what they will allow -- on one listserv and OB said his insurance will not cover him in a lawsuit if he does a TOLAC (trial of labor after c-section) -- he had to do all repeat c-sections.
Now, what to do about the public which demands an antibiotic for themselves or their kids when they're sick? This is a fact. Many providers cave in to satisfy them, which makes the problem worse. More people of lower SES, immigrants, &c, equate getting a drug or antibiotic with the marvels of western medicine and they want to partake of it. They want a shot or a pill. Ethically, we can't give them a placebo although it's likely to be efficacious. Same with inductions and elective c-sections -- these are signs of status, of getting the "best" health care. Or, the poor woman's version is to smoke crack, which frequently causes labor, as well as placental abruption. It's the more educated higher SES classes who recognize the problems with antibiotic overuse and have a critique of the medical system and don't want pharmaceutical or medical interventions, who go to the alternative health practitioner (and have the disposable income to do so), such as the Chinese herbalist, acupuncturist, naturopath, the midwife, &c. So now we've come full circle. The poor, who have no health insurance, see the non western healers because they're cheaper and/or close to their community, as do the rich, but use alternative healing due to an elaborate critique of the system.
I may be working as a travelling nurse in an Indian Health Service hospital in the southwest starting next month. I was told the native women will call in healers to help them if their labor stalls, &c. I am excited at this and wonder if anyone's designed studies as to the efficacy (I know, native americans would not like the idea of a scientific study, but still). I suspect the success rate of the native healers must equal if not surpass use of pitocin and all the other interventive crap we do to women, but do you need to be a Navajo for a Navajo healer to actually help your labor along? Would a blessingway ceremony, for example, help a white woman, or only a Navajo woman? "Science" knows so little about how the mind affects the body and the pain response. The limitations are evident to anyone who's worked with pregnant women and childbirth.
These topics are so complex and so much has already been written about them by experts. My 2 cents.
Grace
Carrol Cox wrote:
>joanna wrote:
>
>
>>Interesting you mention leeches. They are synonymous with medical
>>quackery in most everyone's minds, but the New Yorker ran a terrific
>>little article last year about how medical science is discovering that
>>it has absolutely nothing to beat the ability of leeches to
>>clean/cauterize and help heal wounds of a certain type.
>>
>>
>
>Two points about this.
>
>1. The use leeches were put to (bleeding) was not exactly quackery but
>merely a bad guess by pre-scientific medicine grounded on false
>premises. So that is not really relevant to the present discussion.
>
Not exactly a bad guess more like if leeches are good for X, then
they're good for Y. Modern medicine does this too, for example, using
antibiotics as a cure-all. From what I remember about the New Yorker
article the modern use was also the ancient use; the older use just kind
of went overboard.