In article <1rgo4b$et4@hsdndev.harvard.edu>, rind@enterprise.bih.harvard.edu (David Rind) writes: > In article <1993Apr23.180430.1@vms.ocom.okstate.edu> >  banschbach@vms.ocom.okstate.edu writes: >>I don't like the term "quack" being applied to a licensed physician David. >>Questionable conduct is more appropriately called unethical(in my opinion). >  >>	3. Using laetril to treat cancer patients when such treatment has  >>	   been shown to be ineffective and dangerous(cyanide release) by  >>	   the NCI. >  > Hmm.  This is certainly among the things I would refer to as quack > therapy and would tend to refer to any practitioner who prescribed > laetrile (whether licensed or not) as a quack.  There are unethical > behaviors (such as ordering unneccessary tests to increase fees) > which I would not lable as quackish, but prescribing known ineffective > therapies seems to me to be one of the hallmarks of a quack. > --  > David Rind  One of the responsibilities of a licensed physician is to read the medical  literature to keep up with changes in medical practice.  All the clamor  over laetril resulted in the NCI spending quite a bit of money on clinical  trials which proved(to me anyway) that laetril was ineffective against  cancer.  A physician who continued to use it, when better, more effective,  treatments are available, may deserve to be called a quack.  Anti-fungals  are in a different class.  The big question seems to be is it reasonable to  use them in patients with GI distress or sinus problems that *could* be due  to candida blooms following the use of broad-spectrum antibiotics?  Gorden  Rubenfeld, through e-mail, has assured me that most physicians recognize  the chance of candida blooms occuring after broad-spectrum antibiotic use  and they therefore reinnoculate their patients with *good* bacteria to  restore competetion for candida in the body.  I do not believe that this is  yet a standard part of medical practice.  He deals with critical care  patients where fungal infection(systemic) is a real problem and just  because he tries to keep *good* bacteria in his patients does not mean that  all physicians do this.  I think that aspergillis is more likely to be  found in the sinus mucus membranes than is candida.  Women have been known  for a very long time to suffer from candida blooms in the vagina and a  women is lucky to find a physician who is willing to treat the cause and  not give give her advise to use the OTC anti-fungal creams.  Since candida  colonizes primarily in the ano-rectal area, GI symptoms should be more common  than vaginal problems after broad-spectrum antibiotic use.  The problem we have here David is proof that GI discomfort can be caused by  a candida bloom.  The arguement is that without proof, no action is  warrented.  Medicine has not, and probalby never will be, practiced this way.  There  has always been the use of conventional wisdom.  A very good example is  kidney stones.  Conventional wisdom(because clinical trails have not been  done to come up with an effective prevention), was that restricitng the  intake of calcium and oxalates was the best way to prevent kidney stones  from forming.  Clinical trials focused on drugs or ultrasonic blasts to  breakdown the stone once it formed.  Through the recent New England J of  Medicine article, we now know that conventional wisdom was wrong,  increasing calcium intake is better at preventing stone formation than is  restricting calcium intake.  The conventional wisdom in animal husbandry has been that animals need to  be reinnoculated with *good* bacteria after coming off antibiotic therapy. If it makes sense for livestock, why doesn't it make sense for humans  David?  We are not talking about a dangerous treatment(unless you consider  yogurt dangerous).  If this were a standard part of medical practice, as  Gordon R. says it is, then the incidence of GI distress and vaginal yeast  infections should decline.