Posted by: notdeaddinosaur | January 23, 2012

A Consumer’s View of Alternative Medicine

Alternative medicine is big business. Really big. Billions of dollars big. All that money spent on supplements, acupuncture, homeopathy, reiki, and all those other “natural” cures and remedies should make the savvy consumer sit up and take notice. Or at least look into what’s being sold, by whom, and why. I mean, if all that stuff worked, shouldn’t Americans be getting healthier?

First off, does it work? You may have noticed that almost every alternative practitioner starts his spiel with reasons why “the medical establishment” (that would be me) doesn’t want you to know about their new super-secret cure-all that everyone in China has known about for millenia. Look, I want my patients to be healthy. Trust me: we doctors can make a perfectly good living simply caring for the manifestations of genetic misfortune (cancers, birth defects, etc) and random happenstance (trauma, infections, etc). We have absolutely no reason to “keep people sick” just to maintain our incomes, so let’s not even go there. Ditto Big Pharma. If they found a cure for cancer, they’d market the crap out of it, make an obscene amount of money curing everyone in sight, then quit making it once it went off patent and they couldn’t keep raking in the bucks hand over fist, and not care one bit when people started dying again.

So does this stuff work? Turns out it doesn’t. Legitimate medical scientists have studied just about every kind of alternative medicine out there quite extensively. The US government has spent billions supporting this research through something called the National Center for Complementary and Alternative Medicine (NCCAM). What kind of results have they gotten? This: every single truly alternative therapy studied does nothing. Got that? Nothing. Nothing at all. That doesn’t stop the government from spinning their non-results, though.

Consider acupuncture, a pre-scientific theory of energy meridians practiced in China before they had access to real medicine (and which, by the way, isn’t even mentioned in current Chinese health care policy). The more it is studied, the more it is revealed to be nothing more than an elaborate placebo. That didn’t seem to stop the Director of the NCCAM from writing:

A systematic review of randomized controlled clinical trials of acupuncture for postoperative pain, published in the August 2008 issue of the British Journal of Anaesthesia, demonstrated that acupuncture had clear value,[emphasis mine] that it decreased pain intensity and lowered opioid side effects.

That journal article was something called a meta-analysis. It was a study of other studies of acupuncture, which included all kinds of different methodologies, surgeries, acupuncture techniques; everything. Furthermore, all they looked at were subjective symptoms like pain and nausea, two things that are notoriously responsive to placebos (and that tend to get better with time after surgery). Here’s the actual conclusion from the article:

Perioperative acupuncture may [emphasis mine] be a useful adjunct for acute postoperative pain management.

Can you say “marketing”?

Why are otherwise savvy consumers taken in by this crap? Several reasons:

  • Persuasively misleading salesmen
  • Testimonials
  • Plain old greed and laziness

In many ways, alternative medicine and its hucksters resemble the deceptive financial practices of the unbridled, unregulated denizens of Wall Street. Junk bonds are the homeopathy of investment banking; derivatives are the acupuncture of the stock market; Dr. Oz is the Bernie Madoff of alternative medicine. Didn’t your broker sound like he knew what he was talking about while going on and on about those new mortgage-backed securities? Just like all that talk about “like cures like”, colon cleanses, and energy fields sounds so scientific! Alternative medicine hucksters and boiler room salesmen both know how to dazzle you with impressive terminology that doesn’t actually mean anything. By the way, there are plenty of “real” doctors and “legitimate” financial advisers who fall for this stuff, and unwittingly perpetuate the fraud. Just because your chiropractor or banker believes in something still doesn’t make it true.

Testimonials are for advertising, not for advising. Just because something happened to one person (if it actually happened at all to the paid spokesperson) doesn’t mean you’re going to achieve the same result. Hey, Bernie Madoff made lots of money for lots of people for many years. Lots of those people were telling lots of other people about him before it all went to hell. Just because your mother’s hairdresser’s cousin’s boyfriend’s roommate won a gold medal after taking glucosamine for his knee doesn’t change the fact that the stuff does absolutely nothing.

Consumers fall for bad financial deals out of greed. Many patients succumb to alternative medicine out of laziness. There is no way to lose weight except by eating less. Fat burners, colon cleanses, and cookie diets that promise quick, easy weight loss are nothing but scams. Elaborate vegetable diets won’t cure cancer. Back pain generally goes away, though it may take three months. Quick fixes that sound too good to be true pretty much always are.

If consumers looked at alternative medicine as carefully as they scrutinized their investments, they’d have a lot more money available for investing.

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Responses

  1. Well said. I like your analogy to finance and doctor oz. I do, however, try to keep one small seed of cynicism in my brain. I try to remember to follow the money. Often the best researched cures and best financed trials are those that offer the greatest financial rewards to investors. Trials of alternative cures are usually smaller than the mega trials funded by Pfizer and others. The snake oil is out there, but I am not always sure Who is selling it, having been burned by the hype for rezulin and avandia and actos to name just one class. I like what you have to say. Suppose that makes me a dinosaur also.

  2. Not too long ago I came across an alternative medicine website that was selling colostrum tablets, to “boost your immune system.” Really?! Colostrum??!! Absolutely and utterly ridiculous.

  3. Regardless of its efficacy, I think I may try the cookie diet.

  4. AMEN!

    So many alternative med docs are selling some product along with their services, whether it be snake oil, hormones, vitamins or thousands of dollars of useless lab tests. What amazes me is just how gullible supposedly intelligent people can be when it comes to this stuff.

    I’ve told the story before about my patient who came with a better hrt than the evil drugs I was prescribing and turns out she was taking exactly the same hormone but at 4 times the dose I’d been giving her.

    Keep ranting, me dear. It becomes you.

    Peggy

  5. Pain is a very significant motivator, and isn’t as clearly understood nor as easily controlled as most people think. So if acupuncture can help some people, then why is it a bad thing to try it? And if the medical community has given up hope of improvement in my nerve damaged leg, why shouldn’t I try active release therapy?

    Perhaps it would be worth thinking about what consumers get from the alternative therapies that we aren’t getting from the 10 minutes our doctor can give us. What motivates us to frequently pay out of pocket for the hope of improvement?

    There are really interesting studies on placebo effect and perhaps instead of using it as a bad word, it should be capitalized upon to improve outcomes in medicine?

  6. Our own colleagues make it harder than it has to be. The orthopods in this area frequently tell people to take chondroitin and glucosamine. I guess because a limited specialist says it, it must be true.

  7. I have to say that, depending of course on your semantics, the statement “every single truly alternative therapy studied does nothing” is incorrect.
    Fish oil. Curcuminoids in cystic fibrosis. Hawthorn in congestive heart failure. There are many more examples, but that’s not the point of my comment. Please consider a slightly tempered view; it affects your credibility not to do so.

  8. @Guido: All the therapies you mention are pharmacologic. Any beneficial effects (jury still out on fish oil, to my knowledge) have been demonstrated with standard scientific study. Hence my inclusion of the modifier “truly” before “alternative”. Remember that we call “alternative medicine that has been shown to work” simply “medicine”. My credibility is enhanced by my refusal to accede to the “bait and switch” tactic which includes proven effective modalities of diet, exercise, physical medicine, and pharmacologically active agents from plants under the “alternative” label.

  9. Ok. So if it works, it’s not alternative. If it doesn’t, it is.
    Curious how much effort is spent propping up a tautology.

    As an herbalist, I use active agents all the time. Yet my discipline is lumped in with “CAM”, whatever that is. Seems like artificial distinctions sometimes.

    (and yes, I agree fish oil could use better evidence).

  10. As an herbalist, your work is more correctly known as Pharmacognosy. It is a semantic, logical, and ethical error to lump it in with CAM, but they have to keep some stuff that actually works in order to maintain the bait and switch.

    Yep, once stuff is shown to work, it’s not alternative. What’s really going on is the linguistic shift among quacks/charlatans/fraudulent practitioners. Quackery begat “alternative” begat “complementary” begat “integrative”. Not a tautology; just the continued attempt to make fake medicine seem legitimate.

  11. I appreciate your perspective, but I really don’t think herbalism can be reduced to pharmacognosy, though that is a big part of it.

    Seems to me there are three categories of therapy (with some gray edges obviously): those with clinical evidence of efficacy, those with clinical evidence of lack of efficacy, and those with no / conflicting evidence. Herbalism begets all of these, but the problem is that herbalism has this huge and important spiritual-philosophic component to it that is both highly variable and about as provable as the existence of “god” – thus, it will always fall in the last category.

    Many in the “alternative” world hijack this thread of herbalism and use it for marketing, forgetting that evidence has (almost always) been a component of the discipline historically (see Avicenna, for instance, a fantastic herbalist and a vocal advocate of clinical research). You can’t have philosophy without evidence to validate it! But culturally, people are still used to their medicine having stories attached to it: I really think there is an appeal to sitting under a blooming hawthorn while discussing it applicability in cardiovascular disease and telling fairytales about this spiny tree.

    Conversely, philosophy (and spirituality, whatever that is) can also serve to guide the search for evidence – and it may be the case that without it, no significant breakthroughs are made (thinking of Einstein’s view of inspiration and the mysterious here). Podophyllotoxin, from American mayapple, was used historically for warts and lumps based on an “incorrect” view of reality – but still, that view brought the plant to the attention of evidence-gatherers and a useful therapy was thereby documented.

    The tautology inherent in the statement “once it’s shown to work, it’s not alternative” is that all unproven treatments are unproven. Doesn’t say much. And “every single truly alternative therapy does nothing” is incompatible with your idea that some of what once was alternative can eventually be found effective. So really, it’s just the stuff that has been proven ineffective that really “does nothing”. All the rest – hard to say!

    What really gets me is marketing the philosophy without evidence to dovetail it. Don’t get me wrong, I use wholly unproven therapies like linden tea all the time, largely on faith and personally collected anecdotes, so I’m at least a little bit of a quack. However, I keep what I do connected solidly to biochemical and physiologic science – it would be insane not to do so. But I like being able to present the therapy in another language if I so choose – to honor the desire for meaning and context. The hawthorn has an essence in her – a light that can show you a more open, more relaxed heart. That’s what led us to the lab in the first place. I think it’s worth something.

    Sorry. will shut up now.

  12. Surely you cannot make such brief and sweeping statements about alternative medicine across the board… A little bias perhaps?

    Even if some are placebo, perhaps they are working on some psychological level that ‘real’ medicine doesn’t acknowledge?

    Perhaps it would be more valuable to examine exactly what patients are being offered holistically across the board with alternative treatments? Perhaps there is something to learn from some of their more rounded approaches?

    Perhaps you are feeling threatened by some of these things you admittedly ‘don’t know’. I say all of this with a warm and open heart. I am not affiliated with any alternative medicine. I am just a curious patient.

  13. Soreness is a really extensive motivator, and also isn’t as obviously understood nor because easily managed since most people think. So if acupuncture often helps some individuals, then precisely why is it a bad thing to test it? And if the health community has given up hope of enhancement in my nerve wrecked leg, why shouldn’t I try active release treatment?

  14. If going down the road to the place where I can find a hole with a stone in it, to cure my arthritis, makes me feel better why is it a bad thing to collect loads of them and sell them to arthritic patients for lots of money?

    Carolynsara1- no-one’s saying it’s a bad idea to test it. But when it’s tested extensively, and shown to be a placebo, then further testing is a waste of money and recommending it or selling it would be dishonest. Trying it, no-one would object to, same as no-one would object to me going to find my stone. It’s the wasting of research funds, and the dishonest advice given to patients, that’s objectionable.

    Treya- what do you mean, “working on some psychological level that ‘real’ medicine doesn’t acknowledge”? A placebo will only affect subjective measures, and any kind of treatment can exert placebo effects. That includes ‘mainstream’ treatments: a proven treatment is one that exerts a real effect, as well as a placebo one.

    Alternative medicine doesn’t generally seem to be more ‘holistic’ or rounded.
    I go to my gp, they ask me about my mental health, they check for problems in all the systems of the body and consider multiple aetiologies, they ask about social health, they ask about exercise and diet. I go to a chiropracter and they tell me everything’s due to ‘subluxations’ of the spine (or the ‘practitioner’ down the road who believes everything’s caused by allergies and gut disease, or the other one who believes everything’s bad thoughts). Who’s more holistic there?


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