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.
"These folks are very careful to make the distinction between what is based on evidence and what is based on anecdotes," says John Munce, a 53-year-old management consultant from Charlotte, N.C., who is receiving reiki and acupuncture at the Duke Center for Integrative Medicine following surgery for neck cancer in October. "But I don't care. If it's a placebo, give me the damn placebo." The reiki sessions have restored much of the mobility in his shoulder after a nerve had to be cut during surgery, he says, and he values the psychic benefits equally. "I feel as if the reiki is aligning me to heal," says Munce.
CAM frequently gets undeserved credit because of the natural course of illness, say experts. Most of those who seek out CAM, says Bausell, have chronic problems, perhaps arthritic knee pain or frequent headaches, that follow a predictable cycle: build, peak, and recede. Sufferers tend to seek help when their pain is building, and when the pain, as if by magic, begins to recede after they are treated, it is natural to connect the improvement with the therapy.
Won over. Cycles and disputes over illusory cures don't grab Tracy Gaudet. If a treatment works and isn't harmful, says the Durham, N.C., obstetrician-gynecologist, be thankful. Before having a golf-ball-size mass removed from her neck about three years ago, Gaudet prepped with acupuncture, art therapy, and hypnosis to relieve her symptoms and mentally prepare for the operation. She awoke pain free and never took so much as a Tylenol afterward.