fellowship

Supplemental

One of the things I never really had to deal with in residency, was supplements.

The patient population where I trained was largely rural, minimally educated, and had, for the most part, a paternalistic view of doctors. In other words, what the attending said, went. That’s not to say that adherence wasn’t a problem — the number of patients who presented in status because they didn’t take their meds, or had yet another stroke because they wouldn’t stop smoking, definitely attests to the education and public health challenges we faced as residents.

But until today, I never had a patient refuse treatment in favor of an online supplement.

The supplement in question *seems* pretty harmless. The list of ingredients, posted on the organization’s website, is just a bunch of amino acids. Protein, if you will. I have no idea of the actual doses, but unless they are insane, or unless this guy has terrible kidney disease, he’ll be fine.

But part of me also wants to be like: Why the hell are you buying this crap? You might as well start flushing dollar bills down the toilet. I didn’t say that, of course. I did ask him what he thought the supplement was doing for him, and he said, “I feel less anxious.” Which… I am frankly more willing to attribute to his taking up meditation and Qigong in response to receiving his diagnosis a few months ago. I had some downtime this afternoon so I took a look at the website he mentioned… it’s falling all over itself to state that This Supplement Is Proven By Science! Accept No Substitutes!

So I searched for the Science in question. It took a while, because all the links on the site were for non-scientific lay press articles extolling the benefit of one of the seven amino acids included in this pill (7 for the price of 1! fantastic!). I finally found the study. I’m not going to link to it because it appears to be terrible, and I don’t want to give this supplement any more business. It appears to have been an open-label comparison of oral+IV compound vs. “waitlisted control” whatever that means. A dozen patients in each arm. The results section shows NO STATISTICAL SIGNIFICANCE aside from gender. (Which, wtf, gender? Someone screwed up the “randomization.”) I’m not a statistician or an epidemiologist, but how did this get published anywhere???

Look, friends, I’m a huge believer in non-pharmacologic therapy for PD, and lots of other neurologic diseases too! Diet! (Coffee appears to be neuroprotective, which is excellent for junkies like me Exercise! Tai Chi (shown in multiple RCTs, summarized in a recent meta-analysis [open-access, PLOS One]) is one of the best therapies for PD.  Bring it on, dude.

But if you’re going to be spending hundreds of dollars a month for a pill, why not take levodopa which we actually know WORKS, by both decades of experience and, crucially, actual randomized trials, and also, which your insurance company will pay for?

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