There is no such thing as alternative medicine

What is alternative Medicine, anyway?

That's a great question. I know it is, because I asked it. I get this question almost daily. The secret answer is that there is no such thing as alternative medicine. You don't believe me? Why not--I am a doctor.

There are several ways to define alternative medicine, and sometimes it is contrasted with "complementary medicine". CM refers to treatments that "complement" traditional medicine, while AM refers to treatments that stand in the stead of mainstream medicine. CAM is a broad category used to refer to both.

So what's my problem? How can I say that there is no such thing?

Because "mainstream" medicine is medicine that works. It has been studied, tested, deployed, followed, and it is proven to do what it says. Alternative medicine is any treatment that is not yet, or may never be, mainstream. If it is found to work, it becomes mainstream very rapidly. If it is not proven to work, it remains "alternative".

So, I guess there is, after all, such a thing as alternative medicine. It is any treatment that doesn't work. Why would anyone want that?

There's lots of answers to that question. There are also several incorrect answers. The most common incorrect answer describes a conspiracy of doctors and Big Pharma. Others include the myth that patients are dissatisfied with their physicians and the care they provide. In fact, most people like their doctors. But they like their friends even more, and if a friend testifies about a great new potion, well, why not try it?

Why not, indeed. Your doctor knows quite a bit about the medications being prescribed, and the problems being treated. Your friend, alas, does not.

When someone offers you an "alternative therapy", ask them what it is an alternative to. Does it work better that something else? Is it safer? How do you know? Why should I believe you?

Those questions apply to your doctor as well, but hopefully, you have already decided whether or not you trust your doctor and modern medicine. Try applying this simple test--when you have crushing chest pain and shortness of breath, who do you want to call: the GNC guy or an ambulance?

Maybe further explanation is needed to tease out the difference between "real" medicine and "alternative" medicine.

What's the difference again?

Mainstream medicine is any medicine that works--the problem is the definition of "works". Medical science has fairly stringent standards of evidence. A medicine or treatment is subjected to statistically valid trials, preferably randomized controlled trials, that can be replicated and similar results obtained. They are also proven safe, meaning the risk/benefit ratio is acceptable by some (often arbitrary) standard.

As an example of medical science working properly, let's examine the treatment of heart disease. Over the last 15 years or so, huge advances have been made. For heart attacks, angioplasty or thrombolytic drugs can be given immediately. For ongoing treatment of heart disease, beta blockers, ACE inhibitors, aspirin, and statins are shown to reduce morbidity and mortality. These findings are backed up by repeated, large randomized controlled trials.

An additional negative example is of a particular medication in a class called "inotropes" that was felt to benefit patients with congestive heart failure. This was a logical guess made based on the way the medicine worked and the nature of the disease. A trial was done, and the medication was found to cause excess deaths over the control group. It's regular use in that situation was abandoned (there are limited exceptions).

Examples of alternative medicines that have failed to prove their efficacy include homeopathy and chelation therapy. These have been subjected to scientific study, and they have failed to show efficacy. That is not a moral judgment. Something either works or doesn't.

The other category of treatments are those that have never been subject to scientific scrutiny. Until they are, they should be presumed ineffective until tested, unless there is some compelling reason to believe they are safe and effective, and necessary. Lupron therapy for autism falls into this category.

Calling something ineffective is not a value judgment, only a finding of fact. People who willingly peddle unproven therapies are, however, misguided, if done in innocence, and immoral if done with foreknowledge.

Above, I tried to define what was meant by alternative medicine and what makes it different from standard medicine. In this I used the rhetorical technique of redefining altmed as anything that isn't standard medicine. But a great deal of religious and magical thinking goes on when it comes to alternative medicine.

Why this attraction, worship, reverence for altmed? Mainstream medicine is pretty impressive, with its vanquishing of polio and smallpox, its treatment of heart disease and diabetes. Why does it attract praise, but not adoring worship? It reminds me more than a little bit of the attraction people feel for creationism, despite the beautiful complexity of evolutionary theory.

Ownership and Control

Not everyone can be a doctor. It's long, hard, expensive work: four years of undergraduate, four years of medical school, three years of residency (for internal medicine--much longer for other specialties).

If you wish to involve yourself with altmed, you can be very educated, or not educated at all. It can be as simple as reading a magazine article and deciding that Potion X is a good thing. Anyone can "own" their knowledge of altmed--they don't have to "purchase" it via a long, difficult, expensive education.

But wait, that's not fair! Well, such is life.

Analogy

You don't go to an "alternative" car mechanic--why not? Some families have a long tradition of "being good with" cars. Isn't that good enough? Well, no. You usually take your car to an experienced mechanic who uses books and tools and car manuals to fix cars. But why listen to the professional? You "know your own car" better than anyone else, the sounds it makes, the way it feels--doesn't that count? Can't you use that intuition to fix it? Ever try that? How about an "alternative engineer" to build a bridge?

So why would you with your body? People who believe in altmed aren't crazy (not any more than anyone else at least), so why do they make bizarre decisions regarding their health?

Perhaps it's because people are "closer" to their bodies than they are to their car or a bridge. They wouldn't trust themselves or some shaman to fix the car and drive it across the alternative bridge, but they do feel like they can work with their body more accurately.

They are right. It is impossible to prevent and treat disease without the cooperation of the patient. Patients have to be willing to follow dietary and lifestyle suggestions, take prescriptions when necessary, communicate to their doctors side effects they may experience. They must be able to tell their doctor about financial or other personal difficulties.

That's work. I often have patients keep food diaries to see what they eat, check their blood sugar frequently to make adjustments to diabetic medications, perform preventative exams of their feet and eyes to prevent amputation and blindness. It's hard work to be a doctor, and it's hard work to be a patient. Avoiding it by seeking out voodoo doesn't change that.

You sound angry...are you angry?

Yes. Very angry. The more time people spend seeking "alternatives" to proven medical science, the less healthy they will be. I have devoted my life to preventing and treating disease, and thanks to modern science, I do it well. It pisses me off to see people seduced by purveyors of woo. So, yes, I'm angry. When you see advertisements for "altie" cures, chiropractors, and homeopaths, you should be angry too.

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That's work. I often have patients keep food diaries to see what they eat, check their blood sugar frequently to make adjustments to diabetic medications, perform preventative exams of their feet and eyes to prevent amputation and blindness. It's hard work to be a doctor, and it's hard work to be a patient. Avoiding it by seeking out voodoo doesn't change that.

One quibble here: It can also be very hard work to be an alt-med patient too a lot of the time. Have you ever looked at, for example, the Gonzalez therapy? It involves coffee enemas and taking at least 100 supplement tablets a day--among other things. It's more rigorous and hard to follow than some anti-HIV drug regimens! Ditto some of the "biomedical" therapies for autism, which can involve subjecting autistic kids to rigorous diets, lots of supplements, repeated blood draws, and repeated IV injections of chelation therapy.

Indeed, there are quite a few alt-med "therapies" that are as onerous or even far more onerous than anything we "conventional" doctors do outside of major surgery.

Pedant mode on: alternative medicine doesn't compliment real medicine, it's actually very rude about it. It's complEmentary, but it's never been clear to me quite what it complements.

I'm not convinced by your simplistic binary split between alternative medicine and doctor medicine, nor your analogy of using an alternative car mechanic or fixing a car yourself instead of going to a doctor. True, you wouldn't a reflexologist mechanic to check the tread pattern on the tires to diagnose an engine fault, nor would you want the hole in your tire fixed by acupuncture, and homeopathic screen wash might not give you a good view of the road. But I don't have any problem with changing the spark plugs on my own or having a friend do it.

The difference is rationality. Not all rational stuff is necessarily fully evidence-based with statistically valid trials. Rational might not even be correct; there's a huge difference between taking a pill because you think it might help with some pain and sticking a crystal under your pillow. A better example might be someone who kept a sprained knee warm to help it heal: that's the wrong treatment, but it's a mistake; it's not irrational, just wrong.

And do I know my own body better than a doctor? On some things, yes. My doctor knows more about bodies in general, I know more about what works for me and I have a unique insight into what this bundle of bones and nerves feels like. That's not woo either. A faith healer knows less than either of us.

Maybe I've been unlucky, but I would guess that less than half of my visits to doctors have been useful to me in solving my problem of the moment. So I don't have a hugely high opinion of doctors. But I certainly would never go to a nitwit homeopath, chiropractor, healer, etc.

I think you may have left out an important consideration between

Mainstream medicine is any medicine that works--the problem is the definition of "works". Medical science has fairly stringent standards of evidence. A medicine or treatment is subjected to statistically valid trials, preferably randomized controlled trials, that can be replicated and similar results obtained.

and

The other category of treatments are those that have never been subject to scientific scrutiny. Until they are, they should be presumed ineffective until tested, unless there is some compelling reason to believe they are safe and effective, and necessary.

There are a bunch of studies that give hints of efficacy. For instance, animal studies seemed to show that certain vitamin supplements worked. The studies in humans seemed to show otherwise. The problem, of course, is that it it pretty much impossible to do decent controls in humans. (Well, it's possible but highly unethical.) There are so many confounding factors that we are forced to pull various statistical tricks to mine the relevant factors. But that always leaves a possible gap: maybe it's not vitamin X that effective, but vitamin X together with vitamin Y. Hmmm. That didn't work. Well, maybe it's X with Z.

The thing is, there are so many studies that later studies seem to contradict that it's just not quite as cut and dried as you are implying.

For example, just look at the whole statin thing. They found the correlation between heart problems and cholesterol. Statins lower cholesterol, and taking statins was shown to decrease heart problems. So then the medical consensus was that the link between cholesterol and heart disease was confirmed. And then there was that study on Vytorin, that shows that there is something else going on (possibly, in addition). Or maybe the Vytorin study is wrong. Who knows at this point.

So, while I agree with you in the main, there are subtleties. And there are subtleties that sometimes give the alties ammunition for claiming to fill the gaps.

My Dad is pretty into the whole supplement thing as alternative medicine and I have been generally skeptical. But the great improvement of his health over the last few years which directly coincides with his supplement phase makes me wonder if there isn't something to some of it.

You make a passing reference to some conspiracy theory, but isn't the profit motive (which I think is generally a good thing) an important consideration in what drugs and supplements get researched? With all the supplements already on the market who is going to spend the years and millions of dollars do the proper research if they can't make a profit on it? Things like Ginkgo, Selenium, Nattosimes, Lecithin, Bromelain, and thousands of others may or may not be beneficial but I doubt many of them will be thoroughly tested for decades to come.

Not to mention (as someone wrote above) all the conflicting studies even when they are complete. As someone not in the medical field looking at it from the outside it seems like medical scientific studies rarely produce "definitive, case closed, no need to look at it anymore" results.

Someguy,

Is that the only thing that your dad has changed? Is he eating better, exercising more, stopped a bad habit, sleeping more, etc? I would be interested in knowing. From my personal and definitely anectdotal experience these turn arounds from taking supplements is usually accompanied by other changes in lifestyle that more likely explain changes in health.

Ozzy,

He might be eating better, but he doesn't exorcize at all. A lot of the stuff he eats is for specific alternative medicine reasons. For instance he eats a lot of pineapples specifically for the Bromelain (though Bromelain is available in tablets). He drinks specific types of juices for similar reasons. He eats tomatoes for the anti-oxidents, eats eggs for Lecithin, etc.

Its entirely possible that he would have gotten the same results just by improving his diet generally. Who knows for sure? (and that's kind of the point)

Just curious: What's your opinion of osteopaths? They seem to be in this twilight zone between "allopathy" and alt medicine. Are they mediocre not-quite-doctors? Real doctors with some altie gloss? Or an equally valid but different training background? I'm interested in an MD's perspective.

@Colugo: in the U.S., in the last 20 years or so, most osteopaths undergo the same post-graduate training as M.D.s

@Someguy: There is no evidence to support your anecdote, although it is interesting.

Mainstream medicine isn't medicine that "works", it's medicine that has been tested. Usually that is the same thing, but look at the use of corticosteroids in sepsis. Twice it was tested (in different dosages) and steroid treatment for sepsis became mainstream medicine. Each time after it became accepted practice, further testing showed that it was either ineffective or actually doing more harm than good.

Evidence based medicine is the way to go, but it doesn't mean we always have enough evidence to determine the best medicine, or that current practice is always good practice. We just go with the best information available to us.

It seems to tie into a straight double standard. Formal doctors are very often accused of acting like they know everything without giving proper credit to alternative treatments or to the spiritual elements that may possibly be effective; while at the same time we are expected to be all knowing and infallible with our prescribed treatment. It would be great if society decided which one it was so then we could properly work on that aspect.

By 1st yr MD student (not verified) on 08 Apr 2008 #permalink

You have a typo in the third-to-last paragraph, I think you want to use "Patients" not "Patient's".

Excellent post.

By Copy Editor (not verified) on 08 Apr 2008 #permalink

I have dealt with the apostrophe with great malice. Thank you.

"As an example of medical science working properly, let's examine the treatment of heart disease. Over the last 15 years or so, huge advances have been made. For heart attacks, angioplasty or thrombolytic drugs can be given immediately. For ongoing treatment of heart disease, beta blockers, ACE inhibitors, aspirin, and statins are shown to reduce morbidity and mortality. These findings are backed up by repeated, large randomized controlled trials."

I'm glad you said "For ongoing..." in that quote. I personally take great care to exercise A LOT and try to eat a well-balanced healthy diet. But I have had to turn to some supplements and "alternative" research since I seriously question the motivations of most research today.

In my opinion, pharmaceutical corporations are not really that interested in health issues but rather their overflowing coffers. All the research suggests that cholesterol lowering statins should be taken by everyone, even children. But it doesn't seem to address whether its a good idea to lower cholesterol in anyone but middle-aged, white males, on a SAD diet, that have already had one coronary incident. Since these corporations spend millions on direct marketing and "educating" our medical community I have a hard time trusting my doctor that asked me to lower my fat intake, exercise more and start on fibrates. When at the time, I was on a VLF diet (10% or less calories from fat), and exercising vigorously 2-3 hours a day, every day.

Exercise and diet are key and I'm the first to admit that the success that I have experienced from supplements may be due purely to placebo, but placebo can have a physiological effect and DOES "work."

Luckily I have found a doctor that is willing to accept my skepticism when almost all your so-called studies are funded by pharmaceutical companies with a vested interest in one outcome over another. At the same time he doesn't approve of my unwillingness to get tested for cholesterol. Ill take my chances with what I was born with.

By Richard Levenberg (not verified) on 08 Apr 2008 #permalink

All the research suggests that cholesterol lowering statins should be taken by everyone, even children.

Um, that's not true. I understand your suspicion, but the conclusions are yours, not those of medical science.

While I largely agree with you. Your claim that mainstream medicine is mainstream because it has been demonstrated to work in clinical randomised trials is somewhat misleading; a great deal of medical intervention are performed for the same reason that alternative approaches are used, tradition and unsupported beliefs. This includes many surgical interventions as well as pharmaceutical treatments. That there is a medical culture inertia is reflected by the antipathy that many practitioners (particular in orthopedics) have for evidence based medicine.

Yes, I am a doctor.

What can I say about this post? Amen, man.

"Alternative" medicine is a farce, and it has no business in medical education. Medicine is based on evidence. It is only as good as it's acceptance of reality.

The problem with alternative medicine is that it denies the very concept of evidence.

SomeGuy,

You sound a bit like a 'concern troll' but I'll take the bait a bit, here, since you touched on one of my favorite altie dodges when it comes to 'Big Pharma'.

How come when Pharmaceutical companies make a profit on a drug they pour millions into R&D and licensing for it's all about profit, but when someone sells a 'supplement' (with warning tables all over the bottle 'This product is not intended to diagnose, treat, cure, or prevent any disease') for a profit they're trying to do you a good turn?

By Brendan S (not verified) on 08 Apr 2008 #permalink

Brendan S,

The argument put to me was basically this: Its risking a lot of time and money to do a proper scientific study on a supplement, yes? So will a common supplement, already widely available, be a high priority when competing for finite research dollars with other new drugs that can be sold exclusively by a company? If the motive is profit it seems like its too much risk for too little reward.

I have no problem with either "Big Pharma" or supplement companys trying to make a buck. As I mentioned above) I think the "Big Pharma" profit motive is generally a good thing, but I can see where it might lead to blind spots.

SomeGuy,

But turn the argument around for a moment.

Supplement companies are motivated mostly by profit too. There's no real motivation for them to actually PROVE the effectiveness for their products. People routinely buy supplements that have warnings all over them about not having an effect, more or less. As long as there's enough people out there willing to believe in a given supplement, they're willing to sell it.

Doesn't this create an even larger blind spot in so-called alternative medicine, where there is no money to be made for actually proving an effect?

By Brendan S (not verified) on 09 Apr 2008 #permalink

Bredan S,

I agree. Assuming both arguments have merit where do the blind spots leave us? Unproven claims != disproven claims. Most supplements could be utterly useless, but some could also be quite beneficial and it will be a long time before the proper research is done. That being the case I think many people are not willing to wait 15 years if they suspect they can get the benefits now. I do always wonder where the original claim of a supplements effectiveness in helping with a particular condition comes from.

YOU WROTE : "If it is found to work, it becomes mainstream very rapidly. If it is not proven to work, it remains "alternative".
You are a young MD dreamer for now...

A/ Coronary disease is at 95 % reversible
B / Diabete type 2 ; reversible
C / cancer can be switch off
D / Arthritis can be in most of the case can be reversible
And more.... that you don't know till you start to study alternative medecine. How many of theses results you gat lately ?

I know car analogies are near obligatory, but I don't think yours is actually helping your argument. Would I let, for example, my dad work on my car when I notice it making a weird noise? Just because he's known to be "good with cars" and I have anecdotal evidence that he was able to fix a couple other cars, despite the fact that I know he hasn't had any formal training in fixing cars? Well, yes, of course I would, wouldn't you? Cars are dead simple compared to human-type machines.

By Jacqueline (not verified) on 02 Sep 2009 #permalink

That guy is full of it and has not a clue. Many natural remedies and cures work with great results. Shamans and medicine men also produce excellent results in treating many ailments. The reason much of their medicine may not work on modern ailments is because they used natural medicine in their natural native environment. Humanity is to the ... Read Morepoint of creating its own environment and the subsequent diseases that reflect such conditions. Additionally, I can name one obvious medicine that is certainly deemed alternative and it is known as CANNABIS. The scientific studies show that this natural growing medicine can effectively treat a large variety of ailments with little to no negative effects, especially when vaporized. In addition, it has been the testimony of many cancer patients to be great "complimentary medicine" to treatments such as chemotherapy, which in itself is quite ineffective. Codex alimentarius is evidence of the conspiracy this author denies as is the fact that CANNABIS is still illegal in most states and in Federal jurisdictions.

It is a complete joke. Doctors can perscribe synthetic heroin to patients for pain, which I do not doubt works, but cannot perscribe cannabis in most states. Seriously, talk about absolute ludicracy. The reason for this is that cannabis goes against the agenda of institutionalizing everyone and assimilating them to the machine or cyborg culture in which man is dependent upon machine. Instead of using 10 or so different mainstream drugs, one can smoke some Cannabis and get relief for a variety of symptoms. It also expands consciousness and creativity. Many perscription drugs are habit forming and make the patient dependent upon the Big Pharma system. Do not buy into the doctor who has been indoctrinated and assimilated into the New Age worship of science and technology as if it were the saviour of mankind and the means by which to experience our humanity.

Did you forget to provide full disclosure? I'm sure glad you doctors are so objective and can protect me and my fellow heathen from the alternative medicine pushers. Oh wait, you guys always prescribe off label and the drug industry in recent years gets hit regularly with billion-dollar lawsuits, which they settle - for billions of dollars out of court. I'm glad the evidence is so clear. So it seems you're not really doing anyone a favor here, preach it from the pulpit reverend, these alternative medicine types are the devil!

Their reasoning is straightforward enough: If the gene mutations responsible for diseases in Ashkenazim didn't confer some evolutionary selective advantage, they wouldn't persist. Cochran and Harpending liken these defective genes to the genes in Africans that often deform hemoglobin. Carrying one copy of the gene, most research suggests, helps ward off malaria--surely an adaptive advantage. Two copies, however, cause sickle-cell anemia.

Alt meds are everywhere because people want easy answers. Doing some personal research in peer reviewed journals is hard work and your family doctor, if she's not already part of the big pharma conspiracy, doesn't make sufficiently outrageous claims that her drugs can cure all ills. You're more likely to eradicate the common cold before you can rid the world of nonsense cures and remedies, but good luck to you.

Their reasoning is straightforward enough: If the gene mutations responsible for diseases in Ashkenazim didn't confer some evolutionary selective advantage, they wouldn't persist. Cochran and Harpending liken these defective genes to the genes in Africans that often deform hemoglobin. Carrying one copy of the gene, most research suggests, helps ward off malaria--surely an adaptive advantage. Two copies, however, cause sickle-cell anemia.

@ # 24 and 25

Dave's not here, man!