An Alternative Perspective on Alternative Medicine

You hit a nerve ...

You touched on perhaps my greatest pet peeve with western medicine, and that is the way western physicians like to dismiss therapies that seem to be eliciting a placebo effect as unworthy of consideration, use, study, etc.

But wait! It's the placebo EFFECT! As I see it, any therapy that can elicit this effect is great. And any therapy that could elicit this effect strongly and reliably would be on a path to perfection. IMHO, western medicine is missing the boat on this one.

Responding to Richard...

It's hard to argue with Richard. A therapeutic benefit is a therapeutic benefit. But the key to harnessing the placebo effect--to use it a real clinical weapon--is, as he says, to do so strongly and reliably.

Isn't that a stumbling block of rather large proportions? The response to a placebo can be anywhere from zero to huge depending on the individual, his or her mood and prior mindset, the condition being treated, the persona of the practitioner, the phase of the moon... I don't know how it would be possible to gauge the effect.

Am I not thinking creatively enough?

Avery

Add Aayurveda in our armenorium for treating sufferings of Man kind

In favour of alternative medicine in general and Aayurvedic medicine and medicinal plants in particular:

God has given us body and therefore the remedies too in the form of medicinal plants. Aayurveda is a science practiced on that principle since more than 5ooo years.

If we ignore those plants, we are the looser as human being if we do not use them. We should learn when and how to use them.

We should make research on them before condemning them.

You have rightly said that "Argument by ignorance" will not help the man kind. What ever weapons are at our hand to fight the diseases, we must not be ashamed of using them. We must not refrain from using then just because we do not know about that medicinal value.

Patient wants benefit through any mode of treatment. If Placebo works through psychological suggestion but and useful, why not to use the?

We ride a car and Airplane even we do not have knowledge about their mechanism. Should we continue doing that or not till we master perfection over them?

placebo effect

Try looking into the greater prevalence of alternative methods in Veterinary medicine. Things such as accupuncture, supplements, electronic machines, etc. Now... tell me where the placebo effect comes in when an animal obviously gets better!

It happens. The placebo effect is not the whole answer.

complementary alternative medicine

gradma--as well as the whole of humankind for centuries-- used the garden (as well as other complementary alternative therapies) as her medicine cabinet and beauty boutique. keep an open mind and continue researching and add the good and the proven to man's modern health armory

Alternative Medicine

You're an evidence guy. Here is billion dollar idea for an alternative medicine guarranteed to work and logically sound

Placebos are successful in twenty percent of cases. In fact drugs are tested against placebo effects. Drugs are effective eighty or ninty percent of the time and usually have moderate to severe side effects.

I propose that we sell a placebo over your blog offering a cure in twenty percent of the cases with no side effects for one dollar plus the usual cost of shipping and handling. If it doesn't work the customer needs medical advive. If it works, the customer has saved thousands of dollars in unnecessary tests and treatments.

In response to Avery's comment on my comment, and to clarify where I was headed:

My point was not that we necessarily need to find the magic bullet that distills the placebo effect better than anything else. (Although that would certainly be a good thing. Hmmm. Christian Science perhaps? I know nothing about it -- it just popped into my head. But I digress) My point was that we should not dismiss alternative therapies simply because we can't explain their action, or because we suspect that anecdotal or other results might "only" be placebo effect. If we suspect that we might be eliciting "only" placebo effect, then good! How can we refine our methodology to elicit it all the more, and all the more often?

Accupuncture

I have to say that I became a believer in accupuncture back in 1974. My dad was a surgeon at a state hospital that hosted a Chinese Dr. who used accupuncture in place of traditional anesthesia during surgery. I did a science fair project on the subject and interviewed two hospital staff members who had surgery under accupuncture. Both these nurses explained that they felt absolutely no pain during the procedures and that they didn't suffer from the typical nausea and fogginess typical to general anesthesia. Also, both women recalled being fully conscious during surgery and still felt no pain.

That had me convinced.

There was an article in Time about this fellow back in 1974. In the photo from the surgical suite, you can see my father.

Homeopathy

Just a small point! I treated a medical (sceptic) doctor recently with homeopathic treatment, he could not believe the small white homeopathic pills! and laughed even when I told him he'd only be taking 2 pills.....He'd come to me because his condition was 'incurable' in orthodox terms, he came back 6 weeks later saying he was better and knew it was 'the little white pills'. I asked him if he thought that placebo had played a part, even though he didn't really think it would work, 'no, he felt not, and placebo works so much better anyway with big blue or green pills! he remains well a good year later! thanks to Homeopathy!

For shame

You should be ashamed as a "journalist" to publish such drivel. People convincing themselves that a treatment works does not mean that it does. Correlation does not mean causation.

No trial or study has shown repeatable proof that any of these "alternative treatments" (to call them medicine is insulting) actually do anything, and in many cases they cause a lot of harm. The news is littered with people who seek these "alternative" treatments instead of proper care from a physician, and wind up suffering great consequences.

Think about that before you publish such garbage. If one person reads this report and decides to pursue acupuncture for their asthma instead of medical treatment, and winds up having severe consequences later on, how will you feel?

Your argument about airplanes is invalid. We knew an airplane worked because they *did* work. It was clearly observable, repeatable, and easily testable. There is no such phenomenon here. The results are anecdotal, the effect size is small, and aren't reproducible. They have been invalidated by many scientific studies. Your observation of a few delusional believers (and anyone obtaining such treatment is much more likely to be a believer than not) is not a valid sample. You fall prey to confirmation bias. The many times that it doesn't work or has negative effects are weighed out in people's memories by the few times that (by chance) something does work.

I'm ashamed at what gets published by "respectable" publications in this country sometimes.

The Alternative to Medicine is illness.

For thousands of years people used what we now call "alternative medicine" and the majority of people died relatively young. To quote the December 2007 issue of Focus magazine ""Life expectancy at birth has increased about 20 years over the last 40 years, it previously took from the stone age until 1970 for that to happen." This is primarily due to Western evidence based medicine.

The simple fact is that alt med does not work as proven by double blind medical trials or at best provides a placebo effect. Note that the placebo effect is only you thinking you feel better, the illness you have is still at work on you making you sick and not affected at all by your "positive vibes".

The reason why alt med does not is that at its heart it is based on magical thinking. Most therapies were invented by a non-medical person prior to the 20th century. Lacking basic understanding of medicine these people often mistook the cause and effect of their therapy, usually on a single patient. Armed with this misconception they then sold it like snake oil to the masses. Iridology, homeopathy, acupuncture, etc - they are all nonsense based on ignorance of germ theory and basic human biology.

For anyone wanting a no nonsence view of alt med I highly recommend the Quackcast podcast : http://www.quackcast.com/

Avery Comarow responds...

Jan:

Yes, there are many anecdotal reports of acupuncture's successes with animals. Positive stories of this type naturally get more play than negative ones, however. I don't believe there have been well-done studies.

Morton:

A provocative thought experiment. Unfortunately, the label couldn't guarantee no side effects. In clinical trials of new drugs, quite a few people who get the placebo instead of the real drug experience the same side effects, occasionally just as frequently. I also don't think I'd want to suggest that someone taking Morton's and Avery's Little Placebo Pills has a 20 percent chance of being cured. We'd have to stipulate that only those with a documented belief in the power of placebo can purchase the pills. I'm also uncomfortable with the possibility that someone who's really sick would rely on a sugar pill.

Richard:

No thinking person should reflexively dismiss any claim (cf. Sagan). Sagan was fond of adding, however, that extraordinary claims demand extraordinary evidence.

Layla:

I'm curious: After your father's experience, did he suggest to any of his patients the possibility of substituting acupuncture for anesthesia, and if so did any of them try it? In the 32 years since then, have you used acupuncture rather than anesthesia during a procedure?

Denise:

Experiments with placebos have shown that certain colors really are more effective.

Justin:

I'm not sure whether "drivel" refers to my blog posting or to my alternative medicine story elsewhere on our site. If the story, I'd urge you to reread it. If the former, I may not have been as clear as I could have been. I was musing about the undeniable effect of these therapies for some people some of the time for some conditions. (Is calling such individuals "delusional believers" helpful?) In other words, they work, as I understand the meaning of the word. If you read "Snake Oil Science," biostatistician Barker Bausell's new book, you'll see that he agrees that yes, many of these therapies work. He and I, and many others (presumably including you), are skeptical about the explanations offered by practitioners for how or why they do.

Mark:

I think I was clear in the story about the lack of persuasive evidence for most alternative therapies.

A number of them, by the way, are very recent and were developed by medical persons; Healing Touch and Therapeutic Touch (both proprietary terms) were devised by nurses) are two examples.

More woo

They do not work, as they do not offer results that can be replicated consistently, and fail often under double blind tests.

Working for 1/100 people or 1/10 does not mean that it "works" and actually works the same as, or worse than, a placebo. That doesn't mean we should use these methods instead of a placebo - that means that they don't do anything. The effect size is so small. Drugs are effective 85+% of the time (A figure I've heard from a physician, but cannot cite at the moment), not 10% for certain ailments under the power of Zeus' magical lightning bolts.

No scientific study (without fudged results, microscopic effect size, or improper testing methods/data analysis) backs any of this up. Telling people that they work is dangerous.

Allergies are something that come and go as they please, and with certain conditions. Most people are not qualified to judge the proper conditions, and will put up with a lot in order to convince themselves that they didn't waste their time. I know, as an allergy sufferer myself. I'm not qualified to say that a temporary relief in my allergies means that something cured them, rather than a slight change in pollen counts in the air.

James Randi's $1M prize is still in effect until 2010, I suggest that anyone who has conclusive proof that acupuncture, homeopathy, or any other treatment that has no basis in the realm of science proof apply to take the challenge. It should be a shoe in.

A skeptic of some note once said that "The plural of anecdote is not evidence." Acupuncture cannot cure pain. Water cannot cure anything other than dehydration.

Harnessing the placebo effect? Why? We have things that do work, they're called drugs. Why throw support behind things that don't?

Healing Touch? What the heck? ALL of these crap treatments claim they're based in science, or endorsed by medical professionals. They aren't, or the medical professionals are in on the scam and should be brought up on charges (and some have in the past).

Do you really think that touching someone can heal anything? Come on, you know how the body works. While the placebo effect can be great, we all know it isn't a valid form of treatment - when a clinical drug trial shows an effect size in line with a placebo - the drug is tabled, and considered not to work.

alternative therapies

I seriously doubt that touch therapy, which of course does not involve touching but a sweeping away of the bad energy while talking to the patient in hushed tones in a darkened room, would not stand up to headphones with Celtic harp music playing. If people like this attention, then they should pay for it themselves, not my tax dollars or insurance premium dollars.

I have seen pain relief with acupuncture and I even watched a rat with two needles in its lip cleft have hind limb analgesia every bit as good as stiff shot of morphine. More work with shams is necessary to define its limits. However, the chiropractors in town here are promoting acupuncture for everything--quacks every last one of them. Again, I do not want to pay for it, but they keep hammering to get in the insurance/Medicare door.

Ministry of Truth

An article about "alternative" treatments that does not even mention the largest most evidence based CAM, Chiropractic? Absolutely Orwellian.

Alternative therapies? Think additional.

Justin lefler of NY states, "Do you really think that touching someone can heal anything?" Yes, I do. I was hit by a car as I crossed the street. Both of my tibias and fibulas were shattered. The left tibia had 1/2" of bone missing. The 2 pieces of the right tibia lined up with no gap. Every day I put my hand on my left leg and visulized it healing. It filled in the 1/2" of missing bone in 9 weeks. My right leg didn't heal until I started meditating on it. My intention was not to do a blind study, but that's what happened since all other variables were the same for both legs.

When you can't put any weight on your feet, let alone walk, you will consider anything that will work with your doctor's treatment.

For Shame

Your question, "If there's little risk, why not exploit the therapy?", is dubious, on many levels, and, I think, a shameful episode in the fine history of U.S. News & World Report.

First, is the question of risk: what kind of risk are you talking about? There's the risk of large portions of our population engaging in magical thinking - which most of these potions, etc., rely on - does that bother you?

There's the risk of seemingly harmless treatments causing unseen harm, such as PalMD outlined, recently, here:

http://whitecoatunderground.com/2008/01/15/woo-hurts-it-really-hurts/

And giving someone a sugar pill and calling it medicine is called "lying" (which, as you should know, is unethical.) Is losing sight, of what truth is, something you consider a risk?

And, considering we ARE talking about utterly worthless concoctions, are these "therapies" being exploited, or is it the patients (and their wallets) since they're being fed lies about the nature of this whole quasi-criminal enterprise from start to finish?

Please, Sir, if something doesn't actually "work" (but, instead, is the placebo effect) why refer to it as "therapy" at all? I looked up the definition of the word:

"The treatment of disease or disorders, as by some remedial, rehabilitating, or curative process."

Considering nothing's being treated - and most certainly not cured - I think use of the word "therapy" for this nonsense is inappropriate, don't you? Don't you think such attempts to re-define reality, or just intelligence, downward - to the point where nothing means anything - is a "risk" we should consider?

I could just go on, and on, and on.

Mr. Comarow, since your column is called "Comarow On Quality", you ought to be ashamed. You, Sir, have "drank the Kool-Aid" as the saying goes. Either that or you've lost control of your senses, in which case my heart goes out to you - enough to, at least, suggest you need immediate help. By adding your considerable voice, and the prestige of your magazine, to the chorus of sham artists advocating the equivalent of snake-handling as medicine, you have done yourself, your patients, your magazine, and medicine itself, a great disservice.

Just as no one builds a bridge using alternative engineering, there is no alternative medicine, Mr. Camarow, only medicine,...and I'd suggest you get back to it.

Alterantive Reality

Shocking. The original article discusses therapies of the most benign nature - touch based designed to be palliative in concert with very aggressive EBM (evidence based medicine). I reject the straw man definition of Eastern / Western or lables such as allopathic. A treatment either works or it does not. If you can repeat it, then it can be quantified. There are strong bits of evidence supporting touch as having a positive effect on an individuals state of mind and stress. There is NO evidence that energy fields exists, as is the suggested mechanism of energy therapy and accupuncture.

Your magazine wisely sidesteps the truly ludicrous practices of homeopathy and chiropractic; two 19th century holdovers which have failed to demonstrate a fraction of success, outside of random and self-limiting response.

NCCAM, an arm of NIH has grown to a multi-hundred million dollar organization and has not one effective treatment to show for its supported research. Previous commenters have made salient and realistic points, which I can only second.

There is no doubt that effective therapies can be discerned from unexpected sources, however, without the evidence of trial and test - they are simply elements of wishful thinking.

Alternative Medicine

Concernng the ever-popular and always-evoked "placebo effect," I ask you to consider this: suggestion can indeed bring about relief of symptoms - that's been established by extensive experimentation. Yes, the placebo effect is very real, and effective. BUT: no virus, microbe, tumor, wound, or real organic damage is going to react to suggestion. The question is: "Do you want relief of your symptoms, or do you want to be cured?" Placebo effects bring about relief, but not a cure...

Response to James Randi

I must not have been as clear as I wanted to be. The message I wanted to send in this space that various alternative therapies do offer symptomatic relief; some people want to use them for that purpose; and as long as the risk--however defined--is negligible, I don't have a problem with that. Can those who have commented honestly tell someone who has trouped from specialist to specialist for years for chronic pain not to try, say, acupuncture or reiki because there's no good evidence that they work at all or that their principles are grounded in science?

I'm also not sure I'd go so far as to state unequivocally that "no virus, microbe, tumor, wound, or real organic damage is going to react to suggestion"--assuming that by "suggestion" you're not excluding therapies involving physical intervention of some kind (again, such as acupuncture or reiki).

Oncologist Barrie Cassileth at Sloan-Kettering, the cancer center, told me that acupuncture seems to restore function in the salivary glands of cancer patients on chemotherapy. (Dry mouth is a common side effect of chemo.) This has not been subjected to careful study. But I can see the possibility, given what we are learning about body-brain-body interplay, that a biochemical response could be restorative. Even if it is due purely to placebo, it *is* a reaction.

By the same token, the impact of emotional stress on the immune system is well established, if not well quantified. It is not a stretch to propose that any profound emotional phenomenon, whether caused by stress or belief in the efficacy of an inert pill or sham procedure, might have a similar impact. If so, can we be absolutely positive that a tumor, wound, or real organic damage would not respond?

The Mind/Body Connection Is A Sickness

Whoa - you're not *seriously* going to bring reiki into this are you? (I was married, for 20 years, to a "third degree reiki master" who, eventually, specialized in adultery with a homeopath after I challenged her ability to walk through walls:) There is no touching in reiki, so there's no "physical intervention" involved, except (as my friend, Panda Bear, MD likes to say) shooting invisible fire from your fingertips. Don't you see how far out in la-la land you're heading here? And, as my ex-spouse's example shows, don't you see the inherent problems this mass acceptance of magical thinking can cause for those of us still on planet earth?

As far as 1,000 year old acupuncture is concerned, it's been around long enough for us to know if there's such a thing as "qi" or not - Not - so why try to keep up the "it needs further study" charade? Citizen Deux has already pointed out the hundreds of millions of dollars NCCAM has spent on those worthless studies and we've got squat to show for it. Nada. Zip.

What's deserves more study is the ability of certain people to cling to beliefs that have been proven wrong, over and over, again. All of these "treatments" fall under the rubric of "New Age", and Rosemary Aird, a PhD from the University of Queensland, Brisbane, found "a strong link between new-age spirituality and poor mental health"; something too many believers aren't eager to investigate:

http://www.brisbanetimes.com.au/news/queensland/ diy-religions-cause-more-harm-than-good/2008/01/17/1200419951220.html

As I said to Mr. Comarow, acceptance of New Age beliefs appears to be a sign of a people in need of psychiatric assistance, not attempts to upend what we know, clearly, about medicine. And I'd love to see U.S. News & World Report do a special issue on that because the Western World is, clearly, in danger of losing it's way.

Reply from Avery

In the reiki sessions I attended, the reiki master was most definitely touching. Her hands were beneath the head of the man being treated, on his shoulders, across his chest, and elsewhere.

Touch or no-touch isn't the issue. You want people to stop putting their faith in therapies with no evidence of efficacy and no basis for their supposed effect.

Fine. But (major revelation) they won't. How many of us are consistently analytical and logical about our personal beliefs, decisions and actions? Voting, driving, choosing a mate, judging a friend's conduct.

Does acceptance of unproven therapies really constitute magical thinking? For hardcore adherents, it might. Does that make them unbalanced and in need of psychiatric assistance?

As for non-hardcore people who only want their pain or nausea to stop, I don't see how it is reasonable to say, "No, you can't use [insert alternative therapy], because it hasn't been proven."

Truth

I have real trouble with people like Justin Lefler who deny people's own experience, notwithstanding there's no "evidence-based" justification. He's telling us that even if his allergies are gone, they aren't really gone until what he took that corresponded with their disappearance is proven in RDB studies. He could be allergy-free for years after an unproven treatment, then finally after exhaustive research concluded beyond a doubt that this treatment worked, he would then consider himself cured. EVEN if all these other people who had the same treatment said it worked for them exactly the same way, i.e. they did it and the allergies were gone and haven't returned yet in maybe different alotted times.

Avery, its an interesting question about how many of us are logical and analytical about personal beliefs, decisions and actions. Doesn't it depend on who we are? People like Mr. Lefler *would* be, because obviously his personal motivation lies there.

I think our experience is our truth. There are INDIVIDUAL truths. Hard science in a way is trying to prove we're all the same. That there must be a consistent truth for everyone.

Of course there are mechanisms that can be affected, including in the physiology of human beings, but is a person's truth a mechanism?

So what are we anyways? Something that experiences truth?, or something that responds to a physical stimulus?

Perhaps that needs to be considered when we talk of what works.

Now a cure is a different story. These "Real evidenced-based medicine is the only way" types talk of cures whether by placebo or a drug or whatever in such a one-sided way, again, that is eliminative of pesonal truth or experience. I think Mr. Lefler is only a nose really.

Is a cure simply the the disappearance of symptoms? What if the symptoms come back? Is it still a cure? Funny, I've never heard of anyone saying that they've been symptom free their whole lives after a drug IF they stopped that drug. And certaintly not relatively free of difficulties of any kind. Oops, we can't trust what people say. I guess medicine does somehow cure.

This type of cure has a better name: suppression.

I think a cure involves the complete resolution of symptoms of all systems and diseases, except the very odd acute disease that quickly resolves itself, and at the same time the complete acceptance of one's own truth such that they can freely express who they are in their truth without having to try and prove it to everyone, so that overall, they can be in harmony with themselves relative to their physical and relational environment.

Ever seen a cure like that?

Is This U.S. News & World Report or Mad Magazine?

Mr. Comarow, please, listen to yourself:

Must we all abandon our hard-won educations (and we all have been sick before, many times, without knowing the cause) merely to allow someone else to "feel" better? Is that, seriously, what you're proposing in your role as U.S. News & World Report's healthcare "quality" advocate? If we follow such logic to it's natural conclusion, you're undermining your own authority because there will be no basis on which to judge anything you advocate. Everything will be based on how we "feel" about you - not on any simple-minded measure like whether you actually know - or can prove - what you're talking about.

May I suggest people won't "stop putting their faith in therapies with no evidence of efficacy and no basis for their supposed effect" because other people, like you, keep giving them an out? Homeopathy, clearly, fits that description but the consistent denial that it's just H20 - coupled with the impossible claim it "works" - is madness. If you want to posit that some people get the giggles when crazy, fine, but you are clearly setting up an existential battle when you suggest the rug has to be completely pulled out from under my existence to accommodate their mental problem.

And what do you consider a "hardcore adherent" to reality? (James Randi once had a woman charge him with just that "problem".) As I mentioned once before, how many engineers resort to "alternative engineering" to build a bridge? None, despite bridges being built all the time. Why? Because engineering doesn't give an engineer an "alternative" - he/she will have to be a "hardcore adherent" or everything they work on will fall down. They have to adhere to reality to accomplish the goal. Do you think engineers feel like they're missing out on anything because there's no "alternative"? If there are, I haven't heard of them, have you?

You, Sir, are using your position - and the prestige of U.S. News & World Report - to encourage medical hysteria, can't you see that? As Panda Bear, MD says:

"There are a lot of traditional practices I’d like to see become a part modern medicine. Like snake handling. For my money snake handling has everything you’d ever need in an alternative therapy. You’ve got your snakes representing nature, you’ve got your mystical religious overtones, and you’ve got scads of anecdotal evidence and testimonials in prestigious religious journals attesting to it’s efficacy.

For those of you who don’t know, snake handling has flourished in the folkways of the southern United States for more than a hundred years and is a time-honored method of casting out the demons that cause most sickness, at least those that cannot be ascribed to qi or bad karma. I understand that the NIH offers a fellowship that will equip anyone interested for an expedition to the wilds of Louisiana in which strange and magical land they may sit at the feet of ancient masters of this art and learn the secrets of the serpents."

Sounds plausible, considering your position, doesn't it?

Mr. Comarow, I sincerely don't know what you're trying to do, but whatever it is, it's working, because - as a regular reader of U.S. News & World Report - I simply cannot believe I'm having this conversation.

But I guess that was your goal all along, or am I missing something?

Reply to emcee

Giving them an out? Do you think that more than a minuscule handful of people will try CAM if U.S. News seems to accept it or that an even smaller number of CAM users will stop if U.S. News (or any mainstream media) says it doesn't do anything?

The focus of the cover story was the penetration of CAM into the highest levels of the medical establishment. I found it fascinating, and counterintuitive given the fundamental lack of evidence in minimally rigorous trials and studies. The story noted the lure represented by roughly $250 million a year in federal research funds. And it explored the implications of the placebo effect as well as the natural history of a given illness.

The champions of CAM at these centers may be wrong or misguided, but those I spoke with and whose work I could review aren't kooks ignorant of science, biology, and physics, nor are they cynical quacks looking for a career boost. Investigations into CAM at academic centers may boost CAM's profile and credibility but probably hurts more than helps the reputations of the investigators.

What I've been addressing in this space is a reality that you attribute to mental problems. I'd argue that you mean intellectual blindness or dishonesty, not mental illness, unless you think that the two are synonymous or that rejecting the tools and techniques of science is delusion bordering on madness.

There's no way what I've posted can be extended to acceptance of snake handling. I've repeatedly stipulated minimal to zero risk.

Nor can or should anything I've posted be taken as an endorsement of CAM. Suggesting that I don't see anything wrong with harmless techniques that might offer symptomatic relief when conventional medicine either has failed or has significant risks of its own is hardly the same as a proclamation of legitimacy.

Faith Healing

Most, if not all, CAM cannot be explained rationally. In fact, for most of it, a rational mechanism for how it works cannot even be proposed. There are a lot of medications in real medicine whose mechanism of action is not fully understood but the difference is that we can propose a hypothesis and then test it. Something like homeopathy, for example, defies scientific proof because its premise, that water has memory of long diluted away substance, is not only fairly ridiculous on a third-grade science level but to prove it would require throwing out 200 years of progress in chemistry and physics.

Homeopathy, like most CAM, needs to be accepted on faith and is, in fact, nothing more than faith-healing with the imprimatur of science as a disguise.

If I brought a sweaty televangelist to the hospital and had him cast out demons in the sick you'd be outraged and my hospital would probably get sued. How this kind of placebo effect is different from any other is not clear. The question is not whether people have a right to their faith healers but whether scientists and doctors, people who should no better, should encourage people (and the government) to waste their money when the real medical benefits, as with most placebos, is miniscule at best.

Most CAM is used by the well to treat what are essentially psychological and spiritual problems, not medical ones.

visit www.pandabearmd.com for more on CAM.

Jeez, buddy. I can't believe a guy who ranks hospitals has such a shoddy grasp of medicine.

so called sCAM or CAMs

A successful medical procedure should be consistently effective in a large majority of trials, and be repeatable in the hands of most therapists. Acupuncture does not satisfy these basic criteria in animals.

The American Medical Association's Council on Scientific Affairs stated in a 1981 report that since acupuncture is an experimental procedure, it should be performed only in research settings by licensed physicians or others under their direct supervision. The report urged state medical societies to seek appropriate laws to restrict the performance of acupuncture to research settings

Because Acupuncture is an unproven modality of treatment. Clients should avoid taking the advice of any veterinarian who promotes acupunture in the market place. Clients who wish to try acupuncture should discuss their situation with a knowledgeable veterinarian who has no commercial interest in making a profit from acupuncture.

The use of acupuncture in animals should be restricted to appropriate research settings. Licensure of lay pet acupuncturists should be prohibited or phased out because Acupuncture is an unproven modality of treatment.

art malernee dvm

Hyprocrisy

It has always amazed me that the CAM people are among the first to scream about any "BigPharm" medicine that doesn't live up to its billing, particularly if tests eventually show that it is "no more effective than a placebo", while also saying, about their own ideas, "well, who cares if it is just a placebo effect. People feel better!"

And don't even get me started on their other biggie -- BigPharm exists only to make money. Yeah, and the CAM stuff is given away freely.

Dubious acupuncture claims

"Oncologist Barrie Cassileth at Sloan-Kettering, the cancer center, told me that acupuncture seems to restore function in the salivary glands of cancer patients on chemotherapy. (Dry mouth is a common side effect of chemo.) This has not been subjected to careful study. But I can see the possibility, given what we are learning about body-brain-body interplay, that a biochemical response could be restorative"

This would be the same Barrie Cassileth who recently published a paper in which he failed to find any effect for acupuncture on hot flashes in women with breast cancer on estrogen blockade or who have undergone premature menopause: http://scienceblogs.com/insolence/

2007/12/acupuncture_and_hot_flashes_in_breast_ca.php

Despite the clearly negative findings, he tried to spin the study as possibly being suggestive of being positive.

No, the infiltration of non-evidence-based woo into academic medical centers is not a good thing. It blurs the line between science and pseudoscience, between therapies that are effective and those that are not. Just as medicine is finally strongly moving away from tradition- and dogma-based therapies to finally becoming truly science- and evidence-based, we have this major step backward. As for the "science" supporting these studies, do you know how many false positive studies there are. John Ioannidis has shown that, for studies testing a hypothesis with a low prior probability of being true (many CAM therapies fall into that category based on the improbability of their mechanism or their invocation of "life forces" that no scientist can detect), a high percentage of studies are false positives:

http://www.marginalrevolution.com/marginalrevolution/

2005/09/why_most_publis.html

http://www.theness.com/neurologicablog/index.php?p=8

That's why it's necessary to look at the totality of the literature and include considerations of whether the results of studies are consistent with well-established principles of other scientific disciplines. If they are not, then the results must be truly compelling to make us reconsider such well-established principles. For example, for homeopathy to work as its practitioners claim it does, much of what we know about physics and chemistry would have to be wrong. For us to conclude that to be the case, the evidence for homeopathy would have to be strong, consistent among investigators, and clear-cut. It is not. Ditto <em>reiki</em> and therapeutic touch, which postulate not just a "life energy" that scientists can't detect but that healers are able to manipulate that "life energy" to therapeutic effect.

The bottom line is that much of CAM is, when you come right down to it, religious, not scientific, in nature. If you want to treat reiki like a religion, fine, but don't claim it's science or that science supports it.

If anyone is really interested in seriously grappling with these matters in more detail, let me suggest two excellent sources of further information and thought:

(1) the book "Snake Oil Science" by R. Barker Bausell

(2) the new blog Science-Based Medicine. www.sciencebasedmedicine.org

I second Dr. Hall's recommendation of Prof. Bausell's book "Snake Oil Science" (near the end he even recommends how to find a CAM practitioner!).

Also realize your analogy to airplane flight was very much in error. Pulling out my 30 year old Introduction of Flight textbook by John D. Anderson, Jr (still in print, I just saw it being sold at a college bookstore!), I see the first chapter devoted to the earliest aeronautical engineers, with one section titled "Sir George Cayley (1773-1857) --- the True Inventor of the Airplane". There are historical notes sprinkled throughout the book, from biographies of the Bernoullis and the different control philosophies between the Wright Brothers and European airplane designers.

You should add that chapter to your reading list (it is available in many public libraries). Seeing how Dr. Anderson has been a part of the National Air and Space Museum, you should schedule a visit to learn the history of flight. Though that is my own bias since I spent my last birthday at local Museum of Flight which not only has a replica of the Wright's wind tunnel, but an entire room devoted to them and their work.

Bausell book

I agree that "Snake Oil Science" is a worthwhile resource. It is cited in the alternative medicine story, as is Bausell himself, and leads into a discussion of the placebo effect.

Then you should have read it with better comprehension.

Do tell us what all the studies he cited said about the effectiveness of the various CAMs.

Bausell book

Consider this, from p. 110 of his book.

"Whatever my own views and whatever the value I place on scientific evidence, an eminently reasonable question remains:

'If complementary and alternative therapies do make people feel better, is it important for people to know that the therapies do this for the wrong reason?'

Having such knowledge is seldom of lifesaving significance. Sugar pills are not harmful to anyone other than diabetics, and a passing understanding of the logical, statisical, and emotional reasoning artifact that *may* encourage people to pay others to stick little needles into their bodies or to manipulate their spinal columns is not a major survival skill."

I take that as a "not really."

A little farther down, he also says:

"While the public can be gullible at times, it is not stupid. ...[V]ery few individuals nationwide seek CAM therapies for serious diseases such as cancer or heart disease and hardly anyone does so in lieu of conventional medicine."

Hardly Anyone?

Sure, that's why my mother-in-law is dead, but, I guess, she's "hardly anyone" to some people. Or how about Corretta Scott King? She died in Mexico searching out an "alternative treatment" for cancer; was she "hardly anyone", Mr. Comarow?

And how many "hardly anyone's" are we talking about, to support a multi-billion dollar industry, Mr. Comarow? Enough for the killer quacks, operating in Vegas, to crow they can make it the alternative therapy capital of the country maybe? That's a lot of money for "hardly anyone" to be doing it. Enough for CAM to be in many hospitals in the country - and in the newspapers, promoted on PBS, etc. - while I'm trying to convince my wife, who's not "stupid", that she can't walk through walls or cure cancer with her hands?

Mr. Comarow, I'd say there are millions of them, and they're all "someone" to their loved ones, wouldn't you?

Cool the flames, please

I am sorry about your mother-in-law, who was certainly real and loved. I'm not sure what point you're making about your wife--that she's susceptible to dubious notions because of messages she absorbs from mainstream media? And that these messages tell her she can walk through walls and cure cancer with her hands?

At any rate, reread my post. The words you quoted are from Barker Bausell's book, not from me. I read his book, interviewed Bausell, and returned to it in yesterday's post because of its endorsement by two commenters, and to make the point that Bausell isn't nearly as hard on CAM or those who use it as some of the posters here are. I could quote other parts of the book to the same effect. Has he drunk the Kool-Aid, too?

Avery - Some of your readers have, indeed, started to boil over.

I could easily be one of them, but I'll try to keep the lid on.

Perhaps the reason it frustrates and angers some of us to see a credulous acceptance given to CAM is that we take the question of its efficacy (or lack of it) <em>very seriously indeed.</em> Take homeopathy (please). Would it be surprising if a substance retained a therapeutic effect even after it had been diluted until <em>not one molecule</em> of the active ingredient remained? It would be more than surprising; it would overturn most of what we think we know about physics and chemistry. Now, that could happen -- but it is not very likely. Some really convincing evidence would have to be presented, and instead we have hundreds of studies with negative results. In most of these cases, <b>the jury is in.</b> Homeopathy, therapeutic prayer, healing touch ... have all been studied, and found to work as well as placebos. And your comment was ... what was that again?

<blockquote>

[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), ...

</blockquote>

Avery, I just wanted to cry when I read that one. You managed to get the aeronautical history wrong in a false analogy that evinced a complete misunderstanding of our medical knowledge. It's a trifecta of error. It doesn't help anyone understand the topic at hand. It's ...

Well, OK, I guess I boiled over after all.

When you're wrong you're wrong.

Mr. Comarow,

I am not trying to flame you, and have taken great pains not to insult you, but you seem to be, deliberately, missing or ignoring my point:

This is no academic exercise to those of us who must suffer as the collateral damage of this New Age fad that you - a quality control agent - seem to want to leave open-ended, though you admit there's nothing credible to back it up, but anecdotes and "feelings". You haven't said one thing to indicate you take anything anyone else says seriously, when the facts (which, considering your job, we thought you'd be concerned with) are all on our side. Mr. Comarow, you are wrong.

For me to see this nonsense presented as though there's little to no risk, when I'm telling you, clearly, what those larger risks are and they're huge (and have more than enough links, from around the world, to back it up) while being joined by the likes of James Randi, and some of the other most distinguished and knowledgeable medical and scientific voices on the web, many of whom have studied this topic, from all sides, for years - all telling you you're wrong and the issue seems outside of your scope of understanding - is deeply troubling.

We trust you, Mr. Comarow, don't you understand that? We expect you to return that trust with acknowledging when you're wrong - that's what fair brokers do - and on this, man, you've really blown it. There's more going on here, by a long shot, than you're acknowledging in your coverage or your posts.

The least you could do is address that.

Warning: long response

You have every right to expect that when I'm wrong I'll say so. I was overly glib in suggesting that flight theory is analogous to the topic under discussion. I was recalling a discussion in the aeronautics community a few years ago that made its way to NPR, the New York Times, and other public conduits about alleged misconceptions in longstanding popular explanations of flight. (It also surfaced in an answer in The Straight Dope in July 2005--http://www.straightdope.com/mailbag/mairplanesfly.html.) But my statement was simplistic and sweeping. I should have cited another example, perhaps the bacterial basis of many cases of ulcers. Mea culpa.

I do understand I'm held to a high standard. I should be.

Now let's see if I can bushhog a path out of the underbrush that has piled up.

I am not credulous concerning CAM. I've been subscribing to (and reading) the Skeptical Inquirer for more than 20 years. Two shelves of my office are devoted to books like Bausell's and Robert Parks's. I've read them. I've followed NCCAM from its modest bee-pollen-fueled beginnings.

I've also read every reply to my two blogposts on CAM.

1. If you conclude that I uncritically accept CAM therapies and explanations and endorse their use, that's wrong. Go back and reread the story, my two posts, and my responses.

2. An obligation all reporters face is to keep personal views personal. My views concerning CAM are irrelevant.

3. It was the fundamental clash that got me hooked--our most respected medical bastions were offering, and by extension implicitly endorsing, therapies with little or no explanatory basis and thin or no evidence of efficacy by conventional standards.

4. A phenomenology story has to explore the forces driving the phenomenon. Follow the money. But the infusion of funds also freed up individuals with genuine curiosity and personal convictions to investigate CAM. Their voices are an essential part of such a story. So are the voices of patients. No patient in the story had abandoned conventional medicine. Every one was receiving standard care as well.

5. I hope the story and the explanatory boxes and sidebars were evenhanded but complete, maybe even provoke some to read further.

6. Clinical research is not the same as clinical practice. Research protocols should meet high standards, trials should be conducted in accordance with accepted guidelines, and results should be described fully, honestly, and dispassionately, and should be reviewed by disinterested parties with relevant expertise. Rarely does a CAM trial conform. This should be noted, and was in the story.

In clinical practice, the object is to heal or relieve the symptoms of real patients who come with real complaints. I have stated more than once in these posts and replies that if a CAM therapy represents minimal or no risk, if it is used for relief and not as a cure, and if it is not used instead of conventional therapies unless those have been exhausted, why should a patient with a history of chronic pain or who is going into or coming out of surgery not use it? Because it is woo-woo medicine?

I have yet to read a reply to a question I've posed several times: Would you tell your father or wife or best friend that they shouldn't use reiki or acupuncture or reflexology to try to relieve the pain from bone cancer or an osteoarthritic hip after they've gone through the usual regimen that western medicine can offer, because there's no scientific basis and in fact defies everything known about the body? Orac, what do you tell your patients? In one of my early replies, I quoted a physician who is nationally respected for his work and research into patient-centered care. He sees no reason to discourage patients with chronic pain, for example, from resorting to CAM.

I have always been a fan of thoughtful engagement and appreciate the strong views of those like Orac, whose own blog (Respectful Insolence) you'll see listed among my favorites, along with Science Based Medicine and other blogsites that provoke visitors to consider and reconsider their views. A blog carnival might be fun, with many bloggers in one place to hash out...whatever.

Unfortunately, the Internet does not encourage careful reading and reflection, and does encourage talking past one another. I think some of that is reflected in these posts. Let's have real dialogue. Not that long posts like this one make it easy....

My Last Post

First, to answer your question, yes, I would tell them not to use it. Why? Well, for one, you're paying someone involved in a deception for that deception. (As I said to you, earlier, there's more here than merely the doctor/patient relationship to consider.) No one can shoot invisible fire from their fingertips. 9 year-old Emily Rosa proved it and, if anyone claims they can, they're either criminals or in serious need of psychiatric help. There's no reason to encourage or facilitate it, either way - for any reason. As Panda Bear M.D. once said:

"When you are incapable of asking for proof of the existence of chakra, qi, or mystical fire flowing from the appendages of charlatans, maybe you have become a tad too open-minded. So open minded that you no longer have the conceptual tools to distinguish the right from the wrong, the good from the bad, or the reasonable from the ridiculous."

This is but one of the many "risks" that you seem unwilling to address.

What do you say to the families of the "reiki master", who must suffer his/her ever-growing cultish delusions, once they're propped up by (so-called?) medical science? When they find their lives shattered by divorce (and Steve Salerno, author of S.H.A.M.: How The Self-Help Movement Made America Helpless, found an exact relationship between the rise of New Age/CAM with the divorce rate) what do you say? "Too bad, I didn't mean to help this along, but Mrs. Johnson, in Room 103, had that pain again"?

And, in case you think I'm exaggerating, or dealing with topics (divorce, etc.) outside your range of study, Dr. Graham Sharpe and Dr. R.W. Donnell have, both, called for an attack on what's being called "Quackademic Medicine" - bringing the issue of societal breakdown right into the medical arena. And for what? Because too many doctors lack the courage to admit they, too, are gullible to the entreaties, and medical/spiritual blackmail, of whack jobs who never cared for an education - or the medical profession - to begin with?

You say you've followed NCCAM's development. Did you see this?:

http://www.

quackwatch.org/01QuackeryRelatedTopics/Hearing/gorski2.html

How do you explain it?

The old saying is "The road to hell is paved with good intentions" but Avery My Man, for people like me, you guys are making this particular downward spiral into a ride on a Slip-And-Slide.

But, I guess, such as I don't matter because my mental well-being - or retreating sense of comfort and safety around so-called "science" and "medicine" - will never be included in your assessment of "risk", now will it? No, I gather it's only when you have no more authority, as an authority, that something is likely to 'click' that you've let us all down.

In favor of CAM

I went for alternative medicine treatments, starting last year - CAM (acupuncture & herbs) - and did not expect it to help much because no doctor could help.

I was surprised when it did. No placebo effect.

I had an increase in my energy level, improved digestion & it helped with pain (pain is the only item that insurance covers, if it covers any alt. med.). I am trying it for other things to see what happens.

I only wish that I had "discovered" it sooner! I also wish that insurance had better coverage for it. I think that doctors should suggest it to patients more often, especially when they don't know of anything else that will help.

Maybe a Little More Research Next ?ime

All over the nation, research is being done (and funded by the National Institute of Health) in any number of CAM modalities. I admit I did not read all of the responses in total, so I am hoping that this has already been noted. The National College of Natural Medicine, Helfgott Research Institute and Oregon Health and Science University all work in conjunction to pursue quantifiable evidence in studying conditions such as Alzheimer's, Multiple Sclerosis and HIV support. They study nutrition (considered CAM!!!). naturopathic medicine and classical Chinese medicine under the western medical model.

I don't mean to sound militant, but it seems that the writer of this article did not bother to do much research outside of the MD world. A jaded question will get a jaded answer. Maybe try asking a naturopathic doctor (ND) or university?

Does everyone here know that there are nationally accredited 4 year institutions that train licensed primary care doctors in CAM modalities? Those students must pass basic science boards to complete their education then pass national board exams to practice and in some states must complete residencies prior to practicing. Sound familiar? The requirements to attend one of these schools are nearly identical to MD programs. Naturopathic medicine simply honors "First do no harm," in a way that does not involve unnecessary surgery and prescription dependency.

I am not saying that MDs are wrong. If my arm falls off I want the most highly trained orthopedic surgeon to help me. I guess I wonder why most practitioners and patients of CAM can acknowledge the value of allopathic medicine (MD) but MDs think anything outside of a prescription pad is "quackery."

How to tell what "works"

Penicillin works even when the patient is in a coma. Most alternative treatments work when the patient is awake and knows he's getting the treatment. No matter how impressive your anecdotal experience, the only way to tell whether something really works is to test it with high-quality scientific studies.

R. Barker Bausell explains this and more in his excellent new book, Snake Oil Science.