An Alternative Perspective on Alternative Medicine

I'm sorry—I really didn't intend for the blogless days to pile up like this. The holidays... A day off here and there... And, in particular, a difficult story to write about alternative medicine now up on our website. Blogging chores just had to wait.

A few words about that story and how it evolved. Regular readers (scratch "regular"—anybody who's read a single post) can tell I'm an evidence kind of guy. Claims without backup data give me the urge to turn the page, click on another link, get off the phone. Call it a bias if you want, but every medical reporter knows it's a crucial filter, considering some of the stuff we get from researchers (from their PR agencies much of the time) and publishers.

I suggested an article on alternative medicine because academic medical centers all over the country—venerable altars of clinical research and practice like Mayo and Duke, top-ranked cancer centers, and even children's hospitals—are scrambling to roll out therapies that five or 10 years ago most regarded as dubious at best, crackpot at worst. Acupuncture, homeopathy, herbs, traditional Chinese medicine. It's a fascinating development. And I vowed to report it with an open mind.

When I began my reporting, one of the first things that struck me was that not a single researcher or clinician bothered arguing that the evidence for any of the alternative therapies they were testing and using on patients was persuasive. To the contrary, all agreed that almost none of the studies that show positive results have been designed or run very well.

If I wanted an evidence base, I was out of luck. But absence of evidence, as the late astronomer Carl Sagan said, is not evidence of absence. And if we lack an understanding of or explanation for how something works (as was the case for decades for how an airplane could stay airborne), that doesn't give us the ammunition to state that it doesn't work. In philosophy, that kind of reasoning is called argument by ignorance. Heaven forbid I should be guilty of a sin with "ignorance" in its name.

Some of these therapies, maybe most, do indeed work. The patients I spoke with told me how acupuncture had made their allergies go away, how they were able to avoid painkillers after major surgery because of hypnosis or visualization or other mind-body techniques, how a homeopathic remedy that science would regard simply as water reduced swelling and pain within hours after an injury. I heard many such anecdotes, along with candid appraisals of treatments that seemed to be effective only for a short time or not at all. These people were not all true believers.

It may be that the placebo effect is behind most of the successes claimed for alternative therapies. I suspect it probably is—it can be quite powerful. Suppose we could tap into that power. Maybe we'd need to redefine our thinking about a therapy's ability to work. What does "work" mean, anyway?

I wrestled with the story for weeks, because those patients made a considerable impact on me. Yes, I'm still an evidence guy. I still want well-done clinical trials to be the foundation for care. I still want researchers to set high standards and to meet them before claiming success. But we've been learning some amazing things in recent years about the way the mind affects the body and the body affects the mind, discovering a relationship far more dynamic and interlocked than anyone previously believed. It seems as though many alternative therapies may exploit this relationship. If there's little risk, why not exploit the therapy?