Most CAM therapies remain relatively untested, and the majority of academic centers tiptoe around those that seem especially shaky. "We should always insist on a high standard," says Brent Bauer, director of the Mayo Clinic's complementary and integrative medicine program. CAM therapies for cancer patients at Memorial Sloan-Kettering "have to be rational, and they have to be evidence-based," says Barrie Cassileth, chief of the integrative medicine service and coauthor of the Alternative Medicine Handbook for physicians and other caregivers. Homeopathy is "absurd," she says. "It's like a religion." Nor does she put much faith in energy healing: "Manipulating someone's energy field is nonsense." And while acupuncture is offered at Sloan-Kettering, "we don't do it thinking we're stimulating a vital force—we know we are releasing substances from the brain that make people feel better."
Why not try? Still, some academic hospitals give patients access to highly controversial therapies. Thomas Jefferson University Hospital in Philadelphia and Maryland's integrative medicine center, for example, provide homeopathic services. And patients at Oregon Health and Science University Hospital in Portland and the University of Pittsburgh Medical Center can see a naturopath, generally a non-M.D. who advocates nonmedical aids such as proper nutrition, colonic irrigation (a polite term for enemas), and special water baths to stay healthy without drugs or surgery.
Those who work in academic CAM programs freely concede there is much about CAM that they do not comprehend—yet—but they also argue that the standards of western medicine should not block its use. Just because all of the evidence isn't in, says Donald Abrams, director of clinical programs at ucsf's Osher Center, "should I never try these therapies with my patients?"
A counterargument posed by many critics is that the risks of some therapies are real and the benefits illusory—a placebo effect. That is, even a treatment that does nothing genuine is likely to make you feel better (or worse) if you think it will.
The phenomenon is hardly unique to CAM. Physicians used to hand out inert pills routinely to treat aches and pains. Many still do. A new study found that almost half of the doctors at three Chicago-area medical schools who responded to a survey said they had used a placebo in their practice at least once for anxiety, pain, and other problems. About 1 in 12 reported having done so more than 10 times in the past year.
If CAM's successes are due mostly to placebo, writes biostatistician R. Barker Bausell in Snake Oil Science, a just published book that turns an analytical eye on CAM, not everybody who seeks some form of CAM for a throbbing hip or chronic headache will be happy if he paid (probably out of pocket) for care that only fooled him into feeling better. Health insurers generally cover only a few types of CAM, such as acupuncture, and then only for certain conditions.
As research director of the University of Maryland's CAM center from 1999 to 2004, Bausell became disillusioned when none of several rigorous trials that he helped design demonstrated any benefit to CAM. "The results were no better than placebo," he says. "Zip. So I started asking myself, 'What if there's nothing to this?' "
Here is where the argument gets sticky, because the placebo effect often is, well, effective, notes Don Price, a neuroscience professor at the University of Florida who has made the phenomenon his specialty for more than 30 years. In a major review of the placebo effect published this month, he cites two telling studies reported in 2005 and 2007. In both, patients with various aches and pains received either real acupuncture or a sham procedure that felt like acupuncture; the patients didn't know which one they had gotten. Patients in one study were asked if they thought they had received real or fake acupuncture. Pain relief was greater for those who thought they had gotten the real thing, even if they hadn't, than for patients who thought they had gotten the sham version. In the other study, patients were asked how strongly they believed that acupuncture would help them. The stronger their belief, the better the results—whichever treatment they got.