An Alternative Perspective on Alternative Medicine
Reader Comments
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."
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.
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.
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.
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.
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
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.
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.
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
