Map of life expectancy at birth from Global Education Project.

Friday, July 30, 2010

Alternative Healing Paradigms

Hah! There's no such thing. Either it works or it doesn't.

One of the mixed pleasures of blogging is that I get e-mail from all sorts of people who otherwise live in a parallel universe. A standard claim of champions of complementary and/or alternative "medicine" is that their system or method or practice or whatever it is represents an alternative healing paradigm and therefore cannot be judged by the standards used to evaluate "conventional" or "Western" or allopathic medicine or whatever you want to call it, but needs to be assessed on its own terms. Because I refuse to enter this alternative paradigm and accept the evidence appropriate thereunto, I have a closed mind and I'm arrogant, or whatever the insult of the day happens to be.

An "alternative paradigm" is generally an assertion that all disease, or at least a good bit of it, has a single cause -- usually an "imbalance" of some kind, maybe an "energy" imbalance or low pH -- and/or that all cures derive from some unifying principle, often just a slogan that doesn't have a very specific meaning, such as "like cures like" or "energy rebalancing." A problem that all "alternative" healing paradigms face is that there isn't any good evidence for them, if by evidence we mean the usual requirements of scientific inquiry.

I could waste your time and mine writing about some of these "ideas," a status to which they aspire but do not achieve, but instead I'll just say something about the kind of healing they practice here in the academic medical center where I work. I'll just call it medicine since that's what my employers call it.

Quick -- what is the "paradigm" of medicine, to which my correspondents claim to be alternative? Give up? Good for you, because there isn't one. People are complicated and there are all sorts of entirely different things that can go wrong. Physicians don't fall back on a paradigm to fix everything, they do whatever is likely to work. Antibiotics, surgical excision of tumors, hormonal therapy, receptor blockers, physical therapy, nutrition, prostheses, cancer chemotherapy, cognitive behavioral therapy, social support, surgical repair of joint trauma, monoclonal antibodies, antivirals, vaccinations, and so on and so forth, are all specific ways of addressing various, often entirely unrelated problems.

The only "paradigm" physicians worry about is whether something works or not. The way you find that out is to subject it to rigorous testing. It's often helpful to understand as much as possible about the underlying biological processes that are making a person sick. It can help guide an efficient search for new therapies, and help select the right one for a particular case. But it isn't always necessary -- some remedies are just "empirical," as they say, i.e. they are known to work but people aren't sure why. Doctors aren't above using these, even if they'd generally prefer to know what's going on.

And so, if homeopathy worked, doctors would use it, even though the "paradigm" its proponents claim is absurd and requires overturning all of chemistry, physics, and fundamental logic. But it doesn't work. That's all there is to it. In the poorly designed, poorly conducted, biased and selectively published trials they point to, it sometimes appears to work, a little bit, mostly for vague complaints that normally get better on their own anyway. But the pattern is relentless: the higher quality the experiment, the less it seems to work. In good experiments, it doesn't work at all, it's just a placebo.

That's all we care about folks. You can have your paradigm all you want. But it doesn't work.


kathy a. said...

it's interesting -- one of my friends had surgery for cancer a few months back [not our mutual friend], followed all the medical advice, is doing well. now she is doing some things that she thinks of as complementary -- helping her gain strength and live happily. there's a healthy cooking class; she has discovered drum circles and really enjoys them; and she is doing all these interesting things -- nature photography, art, various things with horses, etc. i see absolutely no down side to any of this.

on the other hand, i recently heard a story about someone's dad. the dad was elderly and had numerous problems: HBP, gout, diabetes, heart problems, kidney problems, foot problems, plus he was nuts in a long-term but undiagnosed way. dad wasn't very good with med compliance, but the worse problem was that he looked into asian herbal medicine "and decided he was an expert." so dad concocted various things in his room, wouldn't tell anyone what they were, even changed the lock so the son he lived with couldn't go in the room. and many times, they ended up in the ER because the "herbal remedies" were interacting with dad's meds.

the dad was, of course, the ideal target for alternative treatments because he was impervious to reason. i have a feeling others fall into them because the selling points make as much sense to them as anything else they hear.

roger said...

i suppose that labeling the alternate paradigm treatments as placebos would give away the game.

i'm looking for meds that have a proven salubrious effect AND a big placebo effect. ice cream works for me.

my new doctor, whose pa urged me to get a colonoscopy (thank you, thank you), has recommended that i skip the hctz and just use lisinopril for hbp. but i still have to monitor my bp. pesky science rules. good so far.

Cervantes said...

I'm 100% for healthy cooking classes, drum circles (anthrax free of course), photography, art and horses. And so are 100% of physicians. I don't know what homeopaths think about all that.

I can't take thiazides because I get postural hypotension. So I take lisonopril and a calcium channel blocker. That's an example of empirical prescribing. My doctor and I screwed around with various combinations till we got one that works and doesn't have side effects.

kathy a. said...

i'm all for ice cream therapy, although usually i don't indulge much any more for calorie reasons. chocolate mint chip is the proven best, successfully treating many ills since my tonsillectomy in 1964, but others suffice. frozen yogurt, especially a soft chocolate/vanilla swirl, is also excellent. your mileage may vary.

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this is a very interesting topics, i really do think that alternative healing is very difficult to understand. Some say it may be because of the patient's faith on the treatment that makes it effective.

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pharmacy said...

I think it's all about perceptions 'cos those "alternative paradigms" aren't a rule.

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