Map of life expectancy at birth from Global Education Project.

Tuesday, February 07, 2006


The subject of what is widely called Complementary and Alternative Medicine (CAM) is one in which I have long-standing interest, involvement, and experience, but have not previously discussed here, for several reasons. But yesterday's post on quackery, while not intended to address the subject of CAM per se, does oblige me to do so now.

A fundamental difficulty with all of the discussion in this area, including some of the most widely cited literature such as the surveys conducted by Harvard physicians David Eisenberg, Thomas DelBanco and colleagues* (e.g., Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Engl J Med. 1993;328 (4):246-252) is that nobody is quite sure what the term means. The Eisenberg surveys included such methods as chiropractic, massage therapy, meditation and even exercise regimens such as yoga among CAM modalities, but these are accepted by most medical doctors as being useful in certain circumstances or even very generally.

Drug companies routinely investigate herbs used in various traditions for efficacy, and even send expeditions to the Amazon jungle to learn from healers and bring back their remedies for study. Many of the most important pharmaceuticals are compounds derived from plants, or variations on those compounds, that were used for centuries or millenia before Merck and Pfizer came along -- NSAIDs, opiates, digitalis, you name it. Of course for many people the bad news is that the drug companies get patents on compounds and make a fortune while the shamans just get their land destroyed by loggers, but that's a separate issue.

A lot of MDs claim there is no such thing as "alternative" medicine -- that if something is found to actually work, according to standards of evidence, then so-called allopathic practitioners (for historical reasons, that's the term for people who go to accredited medical schools and get licensed to practice as M.D.s) will happily adopt it. As I said before, this isn't always entirely true, there is prejudice and resistance to radical ideas within allopathic medicine. Actually the prejudice isn't directed only at people who come from outside of the credentialed, faculty-appointed community. Stanley Prusiner's claims about prions were rejected and ridiculed for years, until they finally became accepted. But they were ultimately accepted, because the evidence was there. Homeopathy, in contrast, has not been accepted because a) trials consistently show it to be no better than placebo, and b) the proposed mechanism of action of homeopathic remedies is completely nonsensical and inconsistent with everything we know about physical reality.

However, many people derive benefit from homeopathic remedies. How can this be? We all know the answer: people often feel better, and even actually get better, when they believe that what they are doing will be helpful. And anyway, most of the symptoms that plague us get better on their own soon enough. Allopathic medicine has a tendency to do too much. Its very powerful interventions can do harm as well as good, and we are often better off leaving well enough alone and letting nature take its course. As I myself said just recently, you're better off drinking ginger tea than taking over-the-counter (or for that matter, prescription) cough and cold remedies. You're also better off taking homeopathic remedies, which are just water, and therefore will not hurt you. If it makes you feel better, who am I to object?

But the real key is that various systems of healing interact with people -- as people, not just biological systems -- in different ways. CAM practitioners as such, people who declare themselves to be non-allopathic physicians, draw on different theories of health and human nature than do allopaths. These theories lead them to ask different questions, speak with and touch people differently, than do allopathic physicians. Their practice settings are different, they may be more available, they may provide a framework of explanation which is comforting. A naturopath or ayurvedic practitioner may have some remedies within his or her kit that are biologically active and would be found efficacious in a randomized controlled trial, and others that are not. Someday those trials may be done, and some of those remedies may be adopted by allopaths.

But in the meantime, people may derive other benefits from their interactions with these practitioners, that they don't get from their M.D.s. They may feel that they are listened to better, that their healer understands what is really troubling them and addresses their emotional, social or spiritual needs better than their allopathic physicians. They may dislike the sterile, impersonal, hectic environment of the hospital and clinic. They may, quite legitimately, fear the potential adverse effects of aggressive medical intervention. They may not want to pay tens of thousands of dollars. Allopathic practitioners would do well to consider these dimensions far more than they do.

However, that is no excuse for quackery. There are a lot of charlatans out there who just want your money, and their remedies are crap. A good salesman convinces even himself of his lies, but they are lies nonetheless.

*Disclosure alert: I am acquainted with Dr. DelBanco.

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