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Published On September 22, 2007

CLINICAL RESEARCH

No Alternative

Despite high patient demand, doctor bloggers argue that complementary alternative medicine may provide more harm than help.

In 2004 at least one-third of Americans sought what is known as complementary and alternative medicine (CAM). Despite evident patient demand, these doctor bloggers argue that such medicine is more likely to compromise than complement care.

A STAGNANT FIELD

Adapted from a May 22, 2007, post by surgeon-scientist “Orac” at Respectful Insolence

To me, there are two categories of medicine: medicine that is supported by high-quality scientific evidence and medicine that is not. The latter category includes plausible treatments that might work but have not yet been shown to work; implausible treatments with little or no evidence of efficacy (a category that includes the vast majority of alternative medicine); and treatments for which the preponderance of evidence shows they do not work.

My guess is that 100 years from now, even if no evidence of efficacy is ever found for therapies such as chelation, laetrile, qigong, Reiki and homeopathy, alternative practitioners will still be using them. Now speculate about how many of today’s “conventional” medical treatments will still be in wide use 100 years from now, and the difference is clear.

Whatever the faults of “conventional” medicine, it does change in response to new evidence. It may take longer than we like and may be a messier process than we like, but it does happen. A more stark contrast with alternative medicine I can’t imagine.

A PATH TO FULFILLMENT

Adapted from an Aug. 9, 2007, post by family physician “#1 Dinosaur” at Musings of a Dinosaur

When people get hurt or sick, their needs, generally speaking, are for an accurate diagnosis and effective treatment that isn’t too unpleasant or expensive from a friendly enough doctor with acceptable facilities. When these needs are met, there is no impetus to seek out alternative care. The system works; everyone is happy.

Often enough, though, not all of those needs are met. The doctor was brusque (but the treatment worked) or the staff was rude (but the doc was great). Or they couldn’t make a diagnosis (but the symptoms resolved on their own) or the suggested treatment was too expensive (but the diagnosis was right and the nurse was wonderful).

The chiropractor, the Reiki master and the acupuncturist manage to meet all their patients’ needs. They diagnose invented conditions, but they provide a diagnosis. They perform treatments that have no scientific plausibility, but “at least they’re doing something.” They spend long periods of time with patients, listening and providing validation that “something’s wrong,” even if the doctors could never find out what. They meet the patients’ emotional need to be heard.

Perhaps some of our energy should be spent improving our job of meeting patients’ needs. Then there wouldn’t be a need for CAM.

DOUBLE BLIND?

Adapted from a May 21, 2007, post by academic neurologist Steven Novella at NeurologicaBlog

The National Center for Complementary and Alternative Medicine (NCCAM), a center within the National Institutes of Health (NIH), ostensibly serves to provide research into CAM claims, but its real purpose is to give CAM a patina of legitimacy. In this it has succeeded.

The NIH has standards by which it decides who deserves money for research, and which are largely based on common sense: Is the research plausible? Is the question important to the practice of medicine? Do the researchers have the necessary experience and resources? NCCAM bypasses this quality control by awarding grants to research highly implausible notions and questions that have already been answered in the negative or by funding studies that are not designed to even address safety and effectiveness.

The double standard also extends to research journals. The National Library of Medicine registers many pro-CAM journals that have a clear editorial bias. Meanwhile they have rejected journals that seek to provide a scientific treatment of CAM as biased.

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