After a terribly painful and debilitating illness, Steve died. He had been treated for Stage 2 Hodgkin’s Disease with a series of intense therapies including German enzymes, American antineoplastins, Mexican naturopathy and Chinese Herbs, complemented by focused meditation, innumerable vitamins, extreme diet modification and acupuncture for severe pain. He fought the cancer with every ounce of his being, doing everything to survive, except the one thing that had an 85% chance of cure; chemotherapy.
I was struck this week by a comment on my website, which bemoaned the highly disorganized state of “alternative medicine” in this Country and in particular the “paltry sums” for alternative research funding by the National Institutes of Health (NIH). The writer suggested that not only could the quality of health be improved with alternative medicine studies, but would go a long way towards saving health care dollars.
It seems to me that the idea that we need more Complementary and Alternative Medicine (CAM) research goes right to the core of the confusion between so called “conventional medicine” and CAM. There is a major difference between the medicine practiced by board certified, classically trained physicians and that of alternative practitioners. That difference is research and data.
If an MD or DO is treating a cancer patient and that patient asks to see or understand the basic science and clinical studies which support the recommended therapy, that published data is readily available. Standard oncology treatment goes through 10-20 years of research, from the test tube, animal studies and through a series of supervised human multi-phase trials, until it is approved and offered to patients. Each step is refereed by competing and critical PhD and physician scientists and must be published in peer-edited journals for general review and criticism, all of which is public and transparent. Where it is not, and when people attempt to manipulate or falsify the system or data, massive blowback eventually occurs.
Alternative medicine, by its very definition, means that it is an alternative to this system of scientific analysis. Essentially, anyone can come up with an idea and without any of the above research steps, provide it to patients. If I decide that sunshine enhanced lemon juice can kill cancer because it is acidic and cancer hates acid, then I can start selling it in pill form tomorrow. If you look at a long list of CAM therapies, that is what they have in common … the shortcut from idea to bedside.
CAM treatments may have long respected histories. Some, like Chinese Traditional Medicine, Ayurvedic Medicine of India, American Homeopathy or Acupuncture, are hundreds or even thousands of years old and have millions of adherents who believe it has helped or even cured them. Often the most vocal support comes from individual patients regarding their own experience with an alternative treatment. Scientists believe that individual case reports are poor substitutes for the objective analysis of hundreds of patients in experimental trials. All CAM therapies have limited or no published research to explain the science of these therapies or to prove they work any better than placebo.
When proper research is performed, certain alternative treatments are found to have value. Vitamin D (with calcium) seems to improve bone density. Acupuncture can treat migraines and prevent chemotherapy-induced nausea. Chiropractic is more likely than orthopedic surgery to return patients with routine back pain to employment. Exercise helps depression and decreases the likelihood that breast cancer will relapse. On the other hand, randomized trials have shown that laetrile (amygdalin) has no anticancer activity and that Vitamin C does not prevent or blunt upper respiratory infections any better than sugar pills.
A key question is that just because the research supporting CAM therapies is limited, does that make them bad? Not necessarily, but it does mean that when choosing such a method of care, patients need to understand they are making the decision based not on a step-by-step scientific process, but on unproven theory. It comes down to trust in the CAM practitioner, because no one, not the person providing the treatment, the patient’s primary physician, nor the patient, has any objective evidence to show that the therapy may help or hurt.
Patients have many reasons to choose alternative treatment instead of or in addition to conventional medical care. The most obvious is the powerful desire to do everything possible to fight the disease, to leave no stone unturned. The need to control one’s destiny, especially if confronted by doctors or a medical system, which seems impersonal, cold and uncaring, drives many patients to seek a different path. Many patients distrust conventional medical care, and most Americans believe conventionally trained doctors either deliberately or by ignorance fail to offer reasonable alternative therapies. For some there is deep mistrust in the objectivity of the “physician-medical school-pharmaceutical-government complex.” Traditional religious, superstitious and pseudoscientific reasoning support the CAM decisions of many patients.
Like most physicians, I have seen many patients hurt by CAM therapies. Some by obvious side effects, such as the woman whose breast fell off after receiving a poultice or the man who had such severe nerve damage that he never walked again. Others delayed life saving therapy with horrible result. Many spent their last dollars without benefit. Finally, other patients undoubtedly experienced side effects and perhaps increased cancer growth because we simply do not have the data on alternative therapies to understand what to expect.
CAM therapies are an alternative to conventional medicine. As we do research on each concept, it will not longer be alternative medicine, but proven or not will fall under studied medical science. I absolutely agree with the comment on my blog that we need to do more experimentation on any therapeutic concept for which there is a reasonable scientific base. Every hypothesis, every dream, every hope must be considered. Nevertheless, until ideas are subjected to the light of scientific scrutiny, each patient and family must understand that by alternative we do not mean a therapy which is proven, but out of the mainstream; by alternative we simply mean unknown.
James C. Salwitz, MD is a Medical Oncologist in private practice for 25 years, and a Clinical Professor at Robert Wood Johnson Medical School. He frequently lectures at the Medical School and in the community on topics related to cancer care, Hospice and Palliative Medicine. Dr. Salwitz blogs at Sunrise Rounds in order to help provide an understanding of cancer.
Filed Under: THCB, The Insider's Guide To Health Care
Tagged: alternative medicine, alternative research funding, CAM, Cancer, Chemotherapy, conventional medicine, Hodgkin’s Disease, James Salwitz, placebo Feb 13, 2013
I know this problem up close and personal.
http://www.bgladd.com/1in3
Still seems like yesterday.
Booby G, I come to this blog occasionally and see your comments here. Thank you for the link to your blog. There’s really nothing I can think of to say except you made your daughter’s life real to me.
The problem is that most conventional doctors feel that alternative medicines are all sham, they don’t beleive that some of them are quite effective and can really save lives. I also get the feeling that most of these orthodox doctors are more interested in the money they are getting from their patients than in finding cure/solutions to the patients’ problems.
If the doctors really care for the welfare of the patients, they would be m,ore open to alternative therapies. The lack of funds for research on alternative therapies means that the big drug companies will keep using every tacctics available to get the doctors to push their drugs to patients even when these drugs have a lot of negative side effects.
With all due respect, Dr. Salwitz, neither vitamin D nor exercise are ‘alternative’ medicine. Therapies which have been scientifically proven are medicine. Therapies that are speculative or delusional aren’t ‘alternative medicine’, they’re not medicine at all.
Use of ‘alternative medicine’, CAM, and so forth are attempts to give stature to practices that haven’t earned it.
There go out of the window the cheaper options of practicing medicine to be replaced by million dollar medicine where supported by advanced technology every organ of yours will be replaced until you put up DNR or DNPT (do not practice technology) sign. I used to think there is a lot of research data behind evidence based medicine until there was article on THCB which lamented FDA does not share research trial data.
100,000 preventable deaths are also the byproduct of the system practiced on evidence based medicine.
The role of doctors, is to get patients healthy and not worship any form of practice. That many patients also get helped by alternatives should make it clear that there are more than one ways devised by nature to heal.
Obviously alternatives is not helped by the fact that quacks are also in the line. But it cannot be any worse than palliatives who bill to the society for nothing more than providing ‘peace of mind’ and those marijuana dealers are saints.
Where alternatives lack in way of unavailable research data they make up in form of referential data. So a greek herbal medicine helped your dad’s nervous condition, chances are it will help you also. I don’t think pharma company had anyone closer in genetic makeup in their trial group. Larger population of alternative medicine follower are from ethnic groups who inherit the medical knowledge and knowledge of their body system behavior from their forefathers based on many generation’s trial and experiment.
The question to be asked is why so many seek alternate cure and why does established medicince feels so threatened about it. It can’t be about patient safety, else why would physicians be for malpractice reform. And what fear when you are backed with trillion dollar research data?
Perhaps I can answer more on behalf of consumers who want to give chance to alternatives as well. First of all, it is their intent to self preserve and no doctor has right to demand that patients sacrifice their life on the altar of their practice of medicine regardless of results. Second reason is cost, since most doctors are are buried under debt of their college or practice loan, they cannot provide cheap care to their dear patients. Alternatives are cheaper. Thirdly, they have testimonials of success of a particular cure so their is desire to try it out. Fourth is fear of side effects like death of evidence based medicine and desire to counteract it, even while continuing the evidence based treatment.
Overall alternative medicine followers are very valuable segment of society. They charge less to the system and will be the one to lead the charge away from million dollar medicine practice and rampant evidence based treatment consumption as if it were some free lollipop that had to be consumed to be a complete human.
@Vikram
Chatter, chatter, like a squirrel in the spring. You throw out assertions such as:
“100,000 preventable deaths are also the byproduct of the system practiced on evidence based medicine.”
with not attribution. Did you pull that out of your backside or off some bat-guano-crazy website offering to cure what ails you with marigold pollen and sweet karma?
I’ll happily engage you in discussing the many issues facing health care delivery but you have to play by the rules.
no attribution? You don’t recognize this widely quoted figure from the Institutes of Medicine “quality chasm” study in 1999? And which 10 years later, the IOM said there was NO improvement? really, who’s being disingenuous here…
Sorry, but I’ve not heard of it. Instead of snarking, how about providing a link?
It is that very arrogance that turns people off to the medical profession. Here is your link (from one of your very own journals) – The Journal of the American Medical Association (JAMA) Vol 284, No 4, July 26th 2000, authored by Dr Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health (Dr. Starfield was ironically killed partly as a result of prescription medicine).
As far as counting on “evidence based medicine,” you would do well to read this too – Lies, Damned Lies and Medical Science – http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/
Reply to “truth” (no “reply” button below the comment”
Thank you very much for that citation – a very interesting article ….
Of course the other issue in mainstream medicine is publication bias. It is getting worse and the efforts to correct it have failed miserably. You can talk scientific method all you want but the disparity between industry and independently funded studies is huge and consistent. The results of these industry funded studies are treated as proprietary information and the results often guarded, just like the formula for Coke.
http://articles.mercola.com/sites/articles/archive/2013/02/13/publication-bias.aspx
So, “Truth”, it is arrogant to ask for a link? Interesting take.
I look forward to reading Starfield’s article in JAMA. Medicine, as a science, is self-reflective. One of the greatest strengths of science is the continuing effort to refine our knowledge. Thanks for the link.
I also found the Institute of Medicine report that Vikram and Kilroy cited. Perhaps they should read it too. Here’s the link:
http://www.iom.edu/Reports/1998/Measuring-the-Quality-of-Health-Care.aspx
It is not arrogant to ask for a link but the many of your responses reek of condescension and don’t encourage engaged conversation (ex. Did you pull that out of your backside or off some bat-guano-crazy website offering to cure what ails you with marigold pollen and sweet karma?). If a statement such as above is not snark, I’m not sure what is?
Constructive conversation requires respect as well as an open mind. You offer to engage in the discussion of this topic but are unaware of one of the most commonly cited references available detailing the risks of modern medicine. It is impossible to teach a man something he already knows.
This documentary provides more insight (some sensationalism but interesting points nonetheless) – http://www.youtube.com/watch?v=h0CQrL5nzwo
Very nice post! I absolutely agree with your overall message.
I do have a couple of (hopefully constructive) comments.
First, many would strongly dispute claims that acupuncture has value beyond placebo, or that chiropractic does anything useful beyond what conventional physiotherapy can accomplish. Interested readers might wish to browse the Science Based Medicine blog for more on these and many other CAM topics.
Also, you cannot actually start selling sunshine-enhanced lemon juice as a cancer cure. Not in the US, at least. You can sell it as a supplement, and you can claim it supports health in various ways. But if you claim it cures cancer, it legally becomes a drug, and selling it without FDA approval becomes illegal.
Truth Says: (no reply below your post)
“This documentary provides more insight (some sensationalism but interesting points nonetheless)”
Some sensationalism, that’s an understatement. Reeks of survivalist/gun owner web site. I’m no fan of industrial corporate farming and try to live by, “buy local first then organic” but our area (as are others) is ripe with locally produced food off the grid. No government raids or arrests. I’m also aware that corporate agriculture is slowly trying to pervert the “organic” label by having more additives embraced in the organic definition. See http://www.cornucopia.org/
Our state and local government is helping small producers by providing centralized processing facility where farmers can add value and sell locally but still retain safe food model where inspections can take place.
Part of the need for FDA and regulations is the size of food handling/processing that is necessary to feed 350 million people cheaply.
I think we pay too little for food where the result is poor health through the fast/junk/processed food model.
“When proper research is performed, certain alternative treatments are found to have value. Vitamin D (with calcium) seems to improve bone density. Acupuncture can treat migraines and prevent chemotherapy-induced nausea. Chiropractic is more likely than orthopedic surgery to return patients with routine back pain to employment. Exercise helps depression and decreases the likelihood that breast cancer will relapse. . . .”
You make a fundamental category error here. To the extent that evidence show that vitamin D and calcium are beneficial in some situations, or that exercise alleviates depression, they cease to be “alternative.” They become part of the repertoire of evidence based medicine. The reason that acupuncture hasn’t made it is that you are incorrect about its value in migraines and nausea. There is no good evidence that it has any benefits beyond placebo, in any situation. And rather than chiropractic being beneficial in low back pain, the real lesson is that surgery is not in most cases. Alas, it’s still done, so we don’t always practice evidence based medicine. But once there is evidence, it’s medicine. So long as there isn’t, it’s (S)CAM.
So people taking Vitamin D before any studies proved its value were being scammed? The benefit isn’t real until it’s been scientifically studied?
Touche!
“The benefit isn’t real until it’s been scientifically studied?”
No, the benefit isn’t proven until it has been scientifically studied.
While many patients have been harmed by CAM therapies, the same is true for “traditional” therapies. As others have stated, the important thing is to determine which treatments work and which do not in well conducted research trials. Those treatments that are supported by the evidence are effective whether they are vitamins, supplements, antineoplastic agents, antibiotics, surgical procedures, etc. I’m not sure the distinction between traditional and CAM therapies is helpful and may be misleading. We need to make sure that patients understand the research evidence about all the therapies they are considering so that they can make informed decisions about their own care.
You say “by alternative we simply mean unknown.”
I disagree. Once something is labeled ‘alternative’ we know a great deal about it. To list a few,
1. we know there is no evidence that it works as advertised
2. we know there is little likelyhood that it does anything useful at all
3. we know that parasites will get wealthy selling it
4. we know Dr. Oz will declare it the medical miracle du jour
In the initial example, the person didn’t try CAM. He just tried “alternative” and didn’t try to complement it with chemo. A sad instance.
There’s plenty of mainstream medicine that doesn’t have the RCT-type research to support the off-label use, but that doesn’t stop doctors from prescribing it thusly. Does that make its off-label use “alternative”?
In a medical environment in which nutrition is considered “alternative,” I have a hard time take these objections seriously. The problem with researching holistic medicines is that they’re holistic — not reduced to a single element. That makes western-trained scientists freak out. Take Chinese classical medicine, with 3,000 years of practical application – if it works, it works, regardless of whether you understand why.
Given how much stuff approved by the FDA is barely better than a placebo, and whose effectiveness varies because of genetics, I don’t see why doctors have a problem with this concept.
Way to go respondents, getting all hung up on how you want to see a word defined. No matter what you want to call it, if there is no data to support its effectiveness over and above placebo, or over and above safer but equally effective treatments, then it cannot be recommended by an allopathic physician. Correcting nutritional deficiencies is always a good idea, using food and supplements as medication without proof of their utility as medication is rarely a good idea. “Off-label” use of “mainstream” medication and those “alternative” treatments that have been developed through years (centuries) of use by skilled practitioners both qualify as examples of promising treatments that warrant further study to determine their actual utility. Anecdotal reports with a sample size rarely exceeding the number 1 do not warrant anything.
Thanks for a post that is understandable to a non-scientist. — a minor question though, do you have any data for supporting MOST? “most Americans believe conventionally trained doctors either deliberately or by ignorance fail to offer reasonable alternative therapies.”
Very awesome post! First, many would highly argument statements that homeopathy has value beyond sugar pill, or that maple grove chiropractic does anything useful beyond what traditional physical rehabilitation can achieve. Fascinated visitors might wish to look at the Technology Based Medication weblog for more on these and many other CAM subjects.
Steve’s incident was pathetic and I think that these alternative medicines really works sometimes and in today’s world there are advances in medical sciences technologies such as prp injections,cardiolgical devices,trigger point injections and other sophisticated items which really heals pain.
This article unfairly compares opposite extremes. Chemo can cure cancer, cancer is life threatening so the risks and side effects are worth it. But what about diseases that can’t be cured by conventional medicine? Autoimmune has no cure and the conventional treatments carry very heavy life threatening risks (cancer included), with very limited success. Yet they are scientifically tested and approved despite these results. With risks like these don’t they belong in the extreme you are placing alternative treatments? And a number of conventional, supposedly properly tested drugs are now being questioned as a cause for autoimmune disease, why didn’t testing reveal this risk? The method of testing we have for new drugs needs to be fast to get the medicine approved to help patients but is that really working or is it just the only means we have to get things out fast? Alternative treatment may not have been tested with “10-20 years of research” but, it does have centuries of applied knowledge! The problem with alternative treatments is not the treatments themselves, it’s the lack of recognition for it’s value in health care. If recognized we would have a better system to support it such as proper regulations and qualifications for alternative doctors and a complementary approach to treatment.
“The problem with alternative treatments is not the treatments themselves, it’s the lack of recognition for it’s value in health care.”
I would argue that alternatives are, in fact, over recognized.
Like Vikram, you are welcome to pursue whatever treatments you’d like. But you need to recognize that medically accepted treatments have generally been evaluated for effectiveness and safety in broad populations and under carefully controlled parameters. This does not mean that they are free of risk; you and your physician must discuss your disease and prognosis, the available treatments and the risks attendant to those treatments. You are ultimately the one who will decide.
When you go to a quack you will hear plenty of anecdotes about relief and recovery; some of them might even be true. But the quackery has not been subjected to the same rigorous studies (and in the few instances where they have, they have almost universally been found wanting) so you have no way of knowing what effect the treatment had, what effect placebo had, and whether or not the result was simply regression to the mean*.
Promoters of ‘alternative’ therapies like to paint an image of a medical establishment that fights to keep ‘alternative’ therapies out. That simply isn’t true. When therapies become proven they are no longer alternative, they are standard medical practices.
Winddriven, by your definition anyone who doesn’t have an MD is a quack? So a Naturopathic Doctor (ND) is a quack for example despite the years of regulated study they follow? And how do you classify a person who had both an MD and an ND? What if that person prescribes a treatment for a patient and its a mix of ‘conventional’ medicine and supplements is that quackery? What if that doctor sends a patient to an acupuncturist? What if that same MD ND prescribes only supplements or only ‘conventional’ medicine? Is it still quackery or do they just have a better range of options by for treating their patients?
One could study astrology for years. It wouldn’t make one a scientist or astrology a science.
Not that that is an answer to my question… but I’ve never heard of an astrologist claiming to be a doctor. For that matter I don’t believe Doctors are Scientists nor are Scientists Doctors unless they have studied in both fields.
@Kelly
Actually, that is a perfectly apt answer to your question.
Medicine is not a ‘pure’ science in that physicians are schooled in a combination of science and evidence-based art. Where the science is clear it takes precedence.
This is rather different than, say, homeopathy or reiki, neither of which has even a scintilla of scientific underpinning. Even acupuncture – the most promising ‘alternative’ therapy – is roughly equivalent to placebo in large scale trials.
By my definition anyone who diagnose and treat disease without an MD is a quack. That especially includes NDs who confuse time spent studying nonsense with time spent studying medicine.
“how do you classify a person who had both an MD and an ND?” As an MD. MDs, like physicists and chemists and astronomers aren’t all alike. You can find an idiot or two in any group.
OK agreed, science based treatments are better than anecdotal claims, especially those from sellers, BUT when you sit in front of your oncologist does he/can he give you the scientific based outcomes of his treatment regime on YOU? And if he did would you really care that there’s only a 5% chance of success? How many oncologists take the, “throw everything and the kitchen sink” approach to cancer treatment?
Show me a study that proves a 100% success rate for all patients and a zero success rate for placebo? Something we don’t understand is going on.
Certainly the ads for “Cancer Treatment Centers of America” where “Care Never Quits” (I assume the billing doesn’t either), promote CAM – is this just a scam?
“can he give you the scientific based outcomes of his treatment regime on YOU?”
Of course not. Individuals are genetically different from one another. So too, not all, say, lung cancers are the same. The question is: would you rather entrust your carcinoma to someone who has spent 6 or so years earning an MD plus several additional years in residency and who is supported by a huge armamentarium of scientific research that is, by the way, constantly being updated and improved … or to a quack?
“Show me a study that proves a 100% success rate for all patients and a zero success rate for placebo?”
Your question betrays fundamental misunderstanding of the placebo effect. Nonetheless, the value of placebo in treating a ‘hot’ appendix is, for all intents and purposes, zero. The success of appendectomy in treating a ‘hot’ appendix is, for all intents and purposes, 100%.
But really, that isn’t how placebo works. In the real world people respond, at least subjectively, to the perception that care is being given. A great example is the Gerson Regimen which involves, among other things, coffee enemas to treat liver cancer. The crankosphere is full of personal testimonials supporting it and the similar Gonzales protocol for pancreatic cancer. But these have been studied carefully and, in fact, patients treated with standard medical care survive 3 times longer and with better quality of life (Oncology 2010 Feb; 24(2):201)
Let’s get little deeper into evidences as an observer.
1. Doctors don’t validate statistics of trial group. Pharma rep flyer tell them it’s done for them.
2. No better than placebo is common cry which flies in face of results of some who benefit from it. Question is who conducts these tests and how do they measure results. Certainly not the homeopathic or ayurvedic or other CAM manufacturers. Why don’t they do it is that, one that they have holistic outlook and secondly they cannot afford to do it. Evidence based is covered by insurance, so sky is the ceiling for price though many trial groups are now formed in developing countries.
3. I know very well about metrics driven healthcare. Kaiser is one of them. It has lowest heart attack rates because that’s their metric. Need it or not you will be fed with statins and aspirin like the live stocks fed with anti-biotics.
People who pay for CAM, pay from their pocket and take their own responsibility and try to figure out best treatment combinations that work for them. They don’t need some dollars off their premium or free gym membership to get incentive to take care of their own health. There is pure capitalism in CAM land. If you get results, you get references and more want to try and you don’t ask others to pay for you and there is no HIPAA, ERISA, ACA, ICD10, HIX, MLR etc.
In the bad land of healthcare, that’s an utopia.
@Vikram C
You are embarrassing yourself by drawing attention to your complete ignorance of science and statistics.
1. Doctors get their information from peer reviewed articles in professional journals. You too can read these articles by going to Pubmed and doing some research before you embarrass yourself further. The abstracts are free but you’ll have to pay for the full text for many of them.
2. Learn statistics. 2a. Manufacturing of supplements is extraordinarily profitable so claiming manufacturers can’t afford it is just silly.
3. This is so incoherent I’m not sure what point you’re trying to make.
Dude, load up on all the CAM you want. But do us all a favor and stick with it. When you have appendicitis, have it cured with reiki. When you have sepsis, get a homeopathic remedy. Don’t take statins, antibiotics or evil, nasty vaccinations.
Best of luck to you, windriven
Hmm. maybe you ought to read Money Driven Medicine by Maggie Mahar or a number of articles by Marcia Angell, M.D, former ed. of NEJM on the games played by pharmaceutical co.s ….
Here’s the problem – the “standard of care” that physicians are required to deliver means they can’t, under fear of malpractice, advise patients to pursue a course of therapy that hasn’t met the wonderful “scientific” standard of approval by FDA or “peer review” or all that. But many alternative therapies which might well meet those standards are never subjected to them because they can’t be patented and thus make a lot of money for some drug company – Some of these plant/drugs have been studied outside of this country and found to have efficacy – but are never taken up here. If we had an FDA that was more concerned about actual healthcare than about facilitating the fortunes of Big Pharma – we would be in much better shape, in more ways than one ….
“But many alternative therapies which might well meet those standards are never subjected to them because they can’t be patented and thus make a lot of money for some drug company”
What delusional claptrap. There is a government agency called NCCAM – National Center for Complementary and Alternative Health which spends well over 100 million dollars per year scientifically studying alternative therapies.
Yeah – i get their updates – totally unimpressed – the stuff they “report” on is just a fraction of what’s out there ….
“CAM treatments may have long respected histories. Some, like Chinese Traditional Medicine, Ayurvedic Medicine of India, American Homeopathy or Acupuncture, are hundreds or even thousands of years old and have millions of adherents who believe it has helped or even cured them.”
I love it – You’ve punched all the right tickets!
1. “Long respected histories…” The “Appeal to Antiquity” logical fallacy!
2. CTM – Long on age old anecdotes and short on real evidence!
3. Ayurvedic Medicine – Notably contaminated with heavy metals!
4. Homeopathy – Don’t even get me started on this archaic superstition!
5. Acupuncture – Prove scientifically that “Qi” really exits or acupuncture is anything more than a placebo effect!
6. “Millions of adherents…” The “Appeal to Popularity” logical fallacy!
7 “believe it has helped or even cured them…” A belief system, not medical science!
Western science – “I am the Lord thy God, thou shalt not have strange gods before me”
Circular reasoning – when you define “truth” as that which has run the gauntlet of western science, anything which has not is therefore “untrue”…
But even if you wish to follow that narrow line of thought, remember that absence of evidence is not evidence of absence …
“the gauntlet of western science”, as you refer to it, is not something that destroys new ideas. It seeks evidence to evaluate claims (hypotheses) using a structured methodology of analyzing evidence in a controlled manner. There is no “Truth” in science, only consensus that is either supported or discarded based on higher quality information collected. The data speaks for itself and it’s self-correcting as further inquire ensues. Your claims of efficacy in alternative treatments often require blind faith. Science has built-in safeguards against bias and beliefs and, by design, owes no allegiance to any dogma like “If it’s natural, it can’t hurt you”.
You are correct – there is no “truth” in science, only a set of rules or parameters whose tests ideas must meet before being considered “legitimate” – that sounds very nice except that
1) those rules and parameters are, as demonstrated over and over, are, in fact, often not met when examined “dispassionately” – though the results of such studies are presented and too often accepted as if they were – and the legitimacy of the whole process, in order to be useful in any meaningful sense depends on folks accepting its legitimacy ….
2) given that the whole paradigm of deductive Western science is perennially subject to Whitehead’s Fallacy of Misplaced Concreteness with its dependence on models – it’s contingent nature is bound to produce flickering results – OK for the mathematical sciences, not so good for the social ones – and medicine has its feet in both camps …
3) there are some very useful things that cannot be squeezed into a test tube or an equation – to exclude their use on that basis is to do a great disservice to patients -
Look, I did all my training in the biological/medical sciences and spent over 20 years in the medical field – and the more i saw the more realized how cramped, narrow and deficient, for all its “wonders” the modern field of medicine is ….
Oooops, you missed one — “personalized” or “genetic” CAM. The current buzz in CAM is therapies that are personalized to the individual’s genome, which is why the therapies cannot be tested on others in statistically valid terms. It ONLY works for that patient.
Why does alternative medicine have to be outside of scientific analysis? If the alternative therapies work, then they should be able to stand up to scientific scrutiny. Scientific as in measurable under controlled conditions and not relying on anecdotal evidence.
That would be good, but who is going to pay for it – the results would not be patentable.
Is prayer an alternative medicine? Millions seem to think so but we don’t hear the medical establishment warning people against it as it does not pass “scientific analysis”.
There is money being made with alternative medicine and some could surely flow into research. After all, all those books, courses, seminars, therapies etc. often aren’t exactly free.
Maybe I’m being too pessimistic or cynical, but to me it seems that in those spheres there isn’t exactly a lot of enthusiam to undergo this much scrutiny.
Prayer, as a form of self-hypnosis, has been at least been examined. Here is an overview: Shapiro et al., Clinical and physiological comparison of meditation with other self-control strategies.
“but who is going to pay for it ”
NCCAM which has spent hundreds of millions of taxpayer dollars.
Thanks for the link, I’ve bookmarked it.
A cursory look returned:
>Meditation Training Program Shows Brain Effects Even Outside a Meditative State (11/01/12)
>Meditation or Exercise May Help Acute Respiratory Infections, Study Finds(07/09/12)
>Mindfulness Meditation Reduces Severity of IBS in Women, Study Finds(09/01/11)
>Mindfulness Meditation Is Associated With Structural Changes in the Brain(01/30/11)
>Transcendental Meditation Helps Young Adults Cope With Stress
(12/14/09)
I have not found many, if any, traditionally trained docs who even consider incorporating CAM in their practice. I guess I’d like to know if it’s even taught in medical school. For sure not many docs in my experience know much about diet as a source of healing.
Usually I find people seek out alternative because they are not getting relief from their traditionally trained doc or they don’t like the drug maintenance (and its side effects) that docs seem to rely on.
Quoted from allopathic trained physician Dr. Carolyn Dean’s website (I became seizure & pain free, off all meds from taking magnesium daily) the last paragraph says it all…
“For the renewal of my medical license I have to complete 50 hours of continuing medical education (CME) that I’m doing online through MedScape. Each time I do my CME courses I’m reminded why allopathic medicine is not working. For example, their list of specialties does not even include nutrition, lifestyle counseling, prevention or anything to do with keeping people well.
The CME cases are all focused on what drugs to give and make no mention of diet or supplements. Even worse, their attitude toward patients is demeaning and unprofessional. For example, in a discussion about constipation induced by opiates used for pain control the following statements are made:
“Patients with OIC (opiate-induced constipation) experience various negative effects on cognition associated with OIC. These include irrational thoughts such as believing that nutrition could improve their constipation, the supposition that constipation indicates deteriorating health, and a misperception that no treatment is available.”
Since when is it an irrational thought to think that nutrition has something to do with constipation? Now, I know they are talking about drug-induced constipation and there’s the eternal bind of drug-taking where the side effects of the drug are treated with another drug. Yet allopathic medicine has turned its back on nutritional solutions to any health problems and demeans people who think otherwise.
Cases describing epilepsy, high blood pressure, atrial fibrillation are all treated with drugs, drugs, drugs with never a mention of magnesium, which can help to heal the condition and not cause any side effects. One case was about the increase of HPV virus in post menopausal women. So, get ready for the next ad campaign to scare these women into getting HPV vaccines!
It’s as if the complexity of drugs and their side effects intrigues doctors and makes them feel useful in diagnosing more problems and treating with more drugs. They would consider diet and supplement advice TOO SIMPLE!
Another CME case was about obesity. More than one-third of adults in the U.S. are obese and about two thirds are overweight. Medicine calls it a serious public health challenge that they are trying to understand. That’s right they say they don’t understand why we are an obese nation and they say nothing about the standard American Diet (SAD). Linked to this case was the disability associated with obesity. Among the 25.3% of adult men and 24.6% of women who were obese, 35.2% and 46.9%, respectively, reported a disability. In contrast, 26.7% of men and 26.8% women of normal weight reported a disability.
Yes, a lot more obese people are disabled but what struck me about these figures is that 26.7% of men and 26.8% women of normal weight are also disabled. That’s over a quarter of the American population disabled. Don’t you find that statistic startling?
After doing several CME cases, I watched a documentary called Sick, Fat and Nearly Dead by Joe Cross. Joe was sick and fat and nearly dead when he decided to take his health into his own hands. Joe’s plan was to juice fast for 60 days during which he lost almost 100 pounds. A trucker named Phil who Joe met on his journey took up the diet and lost almost 200 pounds. Both men are walking miracles and are inspiring others to take charge of their own health. (I’m not endorsing or recommending that everyone go on a juice fast but if you do it while being followed by your doctor, it can be a safe way to detox.)
However, what was truly scary about this film was the dismissive, negative and indifferent attitude of almost everyone that Joe spoke to about his plan to get healthy.
So, in fairness to allopathic medicine, it’s clear that people don’t want to change their diet and lifestyle to get healthy. The tiny percentage that do make a change usually wait until they have one foot in the grave and their prescription pills are not making them better. Only then does it finally sink in that they are responsible for their own health. Medicine just follows the path of least resistance and promises people pills for all that ails them but never a cure.”
Barb –
Thank you for that passage – i am in agreement with it. Though trained in surgery, since my early days i have always thought that gastric bypass surgery in its many incarnations with its many complications was not the best way to deal with obesity … I realize that the excuse is that it is a “quick” way to deal with diabetes, but when you realize that it does so by producing malabsorption, it seems rather clear to me that this is hardly physiologic – it may be “sophisticated” but, IMO, still qualifies as rather barbaric –
i think it is true, and have seen it – modern medicine has sold itself as a quick fix, “easy” for all our ills – take a pill, get an operation, and then live as you will. The problem is that we are still subject to the fundamental rules of Mother Nature – who does pretty well by us if we follow the rules, but is not really amenable to “short cuts”, such as the ones modern medicine seems to promise …
Well OK, but that means they have to have the opportunity to undergo such trials and most have not …
If you think about it, so many of our “tried and true” meds are extracts from some product of Mother Nature – plant or animal – and they undergo testing only when a company can “extract” something it can patent and make money from – so one could actually have a cure for cancer, but if it can’t be patented no one will put up the money to submit it to the rigorous study our system requires for it to be allowed to be “prescribed” ….
“If you think about it, so many of our “tried and true” meds are extracts from some product of Mother Nature”
Aquifer yes, but in their natural form they are not pure nor concentrated enough to have much effect.
Yes, “natural” products are almost totally unregulated, have no assessment of purity and even if there is some evidence of effectiveness, they have unknown and likely variable strength. At least when a pharmaceutical company pursues identifying and purifying the active element of a “natural” product, they are mandated through lengthy FDA phase trials involving tens of thousands patient trials to document safety, side effects, synergistic interactions and efficacy. Have you ever seen a dose/response study for a “natural” product? Who’s watching “natural” products? NOBODY!
” …they are mandated through lengthy FDA phase trials involving tens of thousands patient trials to document safety, side effects, synergistic interactions and efficacy.”
Oh really? Tens of thousands, huh … Would you kindly provide a citation for this “tens of thousands” requirement – and what about the trials they do that show no benefit or actual harm that are never reported or published, that we don’t find out about until years later, when the drug companies knew about them – when enough people have suffered or dies that it can no longer be ignored or covered up?
Rough rule of thumb – wait until something has been out there and in wide use for about 10 years before you use it -
Well actually it appears that extracted and purified, they may well not have much effect either – i.e their effect in a “whole food” is more “potent” which may mean, of course, that it is something other than what has been extracted that produces the desired effect or that the extracted item requires interaction with those “something elses” in the food which gets back to my point about the lack of funded studies for things which cannot be patented and the “requirement” to precisely identify/quantify particular elements so they can be stuffed in the test tubes/equations that are tools of western science …..
What is important is results for patients from the systems of care and not just the science. Here are some parameters for comparison which wil help better evaluate.
1. Completely open trial group data, including that approved by FDA.
2. Comprehensive Comparative effectiveness studies and publication.
3. Actual health results publication. So the physicians should provide health report for long term, say, ten years after procedure completion or the ending diagnosis code. Voluntary health reporting by patients to help that effort.
4. Physicians should post cost data for episode of care on their website. If possible, give a range of package price upfront.
While most CAM doesn’t have good study behind them, what they have is good referential data and many put up package price. Since many CAM therapies focus of holistic health and not a CPT code, comparison is not feasible. Cholesterol may be controlled better by statins, but many believe comes at cost of liver health. Statins will win hands down in controlling this metric but that doesn’t mean better health for patients.
Evidence based medicine is inseparable from it’s finance and support system and their ills. If that rug is pulled under, the expensive castle would come tumbling down.
There are issues at so many layers, that science in background is rendered irrelevant.
1. First of all premise of research is narrow, and it’s a condition and not health.
2. Commercial product related trial data is not completely open or their is FDA review mistake.
3. So there is cost of producing the evidence and then is cost of studying the evidence (physician education), both being expensive proposition.
4. Expense begets more expense and then are insurance, regulation and other induced overheads.
5. Some physician treat to codes(RUC). No one diagnoses outside ICD codes. Many protest lack of payment to call or email patient. Being upto date of scientific research for benefit of each of their patient is just a wishful thinking. Some would be doing that, but formation of initiatives like patientslikeme proves, many patients are at forefront of research.
6. A less scrutinized aspect is the impact on consumer behaviors. The reason you have grandmother’s home treatment and not your brother/sister’s because the grandparent generation did not have insurance. They didn’t get to flash their insurance cards or have the luxury to get drugged and operated at will. They had to endure pain, understand impacting factors and experiment. Now we have generated vast dependent population, who need incentive to get engaged in their own care.
7. At end of it, system is so out of money that there is no will to measure the results. Autopsies are considered hoax science. Negative population level health indicators are thrusted down the throat of those crazy poor people who did not choose to be responsible.
There is no uniform nature to CAM believers and you get luxury of being clubbed with anti-vaccination, anti-infusion, anti-milk many other exotic breeds. However, the core is the people, who believe that evidence based medicine has limitations and many side effects and thus solution must be found to complement and supplement it.
There is a Chinese saying, the person who says it cannot be done, should not stop the person doing it.
As a person who HAD cancer and is part of the traditional medical community I can speak from experience. Arlternative medicine/therapy whatever you choose to call the broad spectrum of it has a place as adjunctive therapy. Unfortunately in most cases slash and burn still is most effective. Adjunctive therapy adds support to traditional treatment and addresses the person perhaps as a whole. To dismiss either can be a grave mistake. Pitting one against another does injustice to the individual. We are seeing the practice of adjunctive therapy in many facilities. I am alive because of surgery, chemotherapy, vitamins, exercise, humor and love.
In reply to “Truth”, Thank you for the link to the article about study bias, I’ve been saying this for years and almost fell off my seat in awe and gratitude to see it in print.
Until modern medicine embraces the patient as a whole, a cohesive unit/feedback system of body, mind and spirit rather than a bag of parts, liquids and chemicals they’ll never discover fundamental laws of nature (vs. sporadic or questionable observations) within all organisms, just like those observed with other sciences.
It took a (unnecessary) full hysterectomy, failed back surgery, numerous other surgeries (to repair the repairs), and opiate addiction recovery for me to take control of/manage my thoughts, emotions and physical health which in reality are not separate but intimately related.
I had to learn the hard way that years of unresolved angers/resentments, a non-whole food/balanced diet, insufficient water and fresh air/outside exercise can lead to ill health. It took alternative methods (EFT, which now does have clinical research/studies) and a loving, forgiving heart, not more medication or surgery for me to be healthy, happy and pain free.
I firmly believe that as more information becomes available on alternative medicine, more people such as jan will be more comfortable with this option rather than ‘slash and burn’.
Some cancers are easier to treat than others. What about liver cancer or metastasized prostate cancer? What’s your record for those ones? Probably not 85%. In those cases, I don’t blame people for looking elsewhere. I have a co-worker who told me a story about her brother. She’s not a health nut or propagandist for anything in particular, and there’s not reason I should believe what she said. Her brother had Stage IV prostate cancer (metastasized). He went to an alternative cancer center just south of the border where he was given various treatments. He is cancer free now. Like I said, I have no reason to doubt my co-worker’s story. How does regular oncology do for this kind of cancer?
Sorry, made a typo – I meant that there was no reason I should disbelieve her.
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With the ever increasing challenges in all facets of health care, why are more Physicians not demanding that we at least start a crash program to actively and objectively research the potential and possibilities of Medical Marijuana.
Patrick Monk.RN.