Friday Rants: Complementary and Alternative Medicine Needs to End

Complementary and alternative medicine has no business participating in mainstream science or medicine.

As I understand it, there are five core premises on which complementary and alternative medicine is based. I would like to confront each in turn:

  • 1) The evil, old white men who run the medical establishment are united in a vast conspiracy to suppress legitimate treatments. If we had only looked to folk remedies sooner, we would have cured things like cancer and Alzheimer's long ago.

Think about that for a second: do you sincerely believe that everyone -- I mean everyone -- in the medical establishment is so crass, so blind, and so mean to consign people to die if there were better options available? To believe that about an group of people requires a such a cynical view of humanity that it makes me shudder.

And you have to believe that it is everyone. If there were even a single individual who believed otherwise, imagine the incentive they would have to break rank. Imagine the money and the fame that they would receive for curing Alzheimer's. Not only must you believe that this huge group of people is evil, you have to believe that they are capable of suppressing dissent. Has any group this large in the history of humanity ever maintained homogeneous beliefs for a such long period of time?

Believers in CAM operate under the insane delusion that good treatments are being suppressed by greedy men and women. The truth is that everything about the structure of our society guarantees that if those treatments existed, they would have been forced into the public light long ago. There are some diseases we simply do not know how to treat.

This is not conspiracy; it is reality.

  • 2) There are mysterious and unidentified toxins permeating our world that justify the recourse to a more natural lifestyle.

When confronted with someone who believes the toxins hypothesis, I often ask what a scientist should ask: what toxins are present, in what dose, and what is the mechanism of injury? To these questions, CAM responds that identification is unnecessary, dose is irrelevant -- and should in ideal world be zero -- and that mechanism is _____... we don't know...they make people feel bad, I guess. (Such reasoning is enough to make a toxicologist go insane.)

By this response, the toxins are revealed and the ghosts and genies they truly are. They aren't tangible because then they would be susceptible to analysis. Rather, they are symptoms of the modern predicament, a feeling about a world that has become too mechanized and complex -- or in my terms: they are all in peoples heads.

If you believe there toxins in the world, prove it. Show me which ones. Show me their effects.

  • 3) Natural remedies are superior to modern medicine because their are not artificial.

The universe is filled with atoms, and these atoms form into molecules. Some molecules are complex and form into living things. Other molecules are toxic to the living things. There is no distinction, however, between artificial and natural molecules. There are only molecules. An atom of carbon in a diamond is the same as one in a sugar molecule.

I could in the lab, if I chose, manufacture nearly every chemical that is present in your body. Would the fact that I manufactured these chemicals in the lab make them less natural? Of course not. By any test that you could contrive, these chemicals are identical to the ones found in your body.

The point of all this is that no discussion about the functions of molecules can take place with out first identifying the molecule in question and its mechanism of action. This is my same response to people who respond that herbs have yielded numerous useful drugs. Yes, they have, but what was the molecule in that herb that had that effect? To make it into drug, some scientist had to purify it and confirm that it had the desired effect. Scientists did not just go on faith. They checked, and proved that it was so.

And it was science, not CAM, that did this.

  • 4) CAM is intended to assist traditional medicine and science, not to supplant them.

First, what is CAM bringing to the table that science and medicine didn't have? Good feelings. Acquaintance with the ways of ignorance. Newer, better superstitions. Frankly, you can keep them.

Two, CAM exists as an expression of the worst type of identity politics. Groups that feel that they are underrepresented in the medical establishment have attempted to address this by forcing CAM. While I certainly agree the medical establishment is still (sadly) very white and very male, the solution to the problem is not to form an alternative, shadow medicine with different -- and frankly lower -- standards. The solution is to force the medical establishment to accept that diversity is a pre-requisite for quality care.

Three, there is an entire institute of the National Institutes of Health devoted to CAM (NCCAM). What has this institute produced? Name me a single drug or treatment. And their budget is like $100 million. (Orac has the sad story on NCCAM covered.) It incenses me beyond reason that at the same time that researchers are being refused funding for experimentally-established, mechanistically-justified, and theoretically-consistent research, NCCAM is giving away money to study sorcery. If the purpose of NCCAM were to debunk this quackery that would be fine, but to subsidize it?!

Economics tell us that all choices carry opportunity costs. In a world filled with opportunity costs, why would I waste my time and money trying to assist something that works pretty damn well already?

  • 5) CAM makes people feel better.

Ah, there's the rub. If you fight with someone about CAM, this is where you usually end up.

My parents taught me that when you hide reality from someone, you both pay. I'll give you an example, if your brother had a drug addiction came to your house wanting to stay, would you let him? What if he refused to seek treatment for his addiction? His alternative might be sleeping on the street, but in your home he will likely continue to abuse drugs.

I say no. It is not good for you to allow him to stay; you will have to deal with his nonsense. And it is not good for him either because in sheltering him you will only further enable his addiction. In the long run, it is better for you to force him to confront the stark choices of reality than to shelter him in complacent delusion.

It is true that it may make people feel better if you say these treatments work. However, you are doing neither them nor yourself any favors.

Science complemented by non-science ceases to be science, and there are no alternatives to the truth.


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I agree with your points up until point #5. It is kind of hard to argue with feeling better. It seems to me that medicine will be better served by finding out exactly what need it is CAM is filling and then work to fill it better. Then with points 1-4 in place, medicine will be clearly superior. I don't think we take enough look at our responsibility as a medical profession for the rise in CAM. To me it boils down to respect and communication.

"To me it boils down to respect and communication."

I disagree. There's only so much communication you can do in a limited amount of time. Do you want to lay out points #1 through #5 for every patient? Do you think 15 minutes of respectful communication can overcome irrationality that's been built over a lifetime?

CAM enjoys the luxury of being "intuitive" to the scientifically illiterate. IMHO, science illiteracy is better corrected in an educational setting rather than a medical setting. (opportunity cost: doctors' times are more expensive than teacher's times)

By Biomed Tim (not verified) on 01 Feb 2008 #permalink

"In the long run, it is better for you to force him to confront the stark choices of reality than to shelter him in complacent delusion."

Yo Jake, you're brilliant insight on coddling drug abusers may be needed at the ONDCP. Alternately, I hear the San Diego County of Health may be hiring.

While agree that in many cases individuals put far too much faith (and investment) in CAM, it is my opinion that you are going too far in making a blanket statement. While the majority of CAM probably does boil down to placebo effect (at best) or outright hokum (at worst), there is still value to be gained in objectively examining whether there a given approach does contain some useful kernels for science to expand upon. Your stance would seem to prohibit even that.

I'm also disappointed at your use of straw-man arguments, as well as convenient omission of any mention of harms that have been done under the auspices of science-based medicine. If you're going to attack the worst abuses in the system you oppose, you should at least recognize similar abuses in the system you support. Notwithstanding that portrayal of the opposing side, a surprising number of your assertions contain holes big enough to drive a truck through.

I'd love to know what prompted this particular diatribe.

Don't misunderstand. I'm no big fan of woo, and in the course of giving it the benefit of the doubt at various points, I often found it ineffectual or worse. But that is hardly proof that every last bit of alternative medicine is similarly flawed.

I realize this is a rant, but this time you were overly harsh, I'd say. True, CAM as a replacement of mainstream medicine is impossible, but nobody in their right mind would argue for that. There is, however, some middle ground between all CAM and nothing. What is wrong with relying on peppermint oil for getting rid of an occasional headache, instead of aspirin, for example? So, while I agree with you on #2 and #3, the rest of them are not quite as wrong as you make them out to be.

Barbara, you're right that nobody in there right mind would argue for using CAM instead of reality-based medicine. Unfortunately there are tons of people not in their right mind, at least when it comes to science and medicine. Kevin Trudeau has national bestsellers advocating quackery. I would say that's proof that there many people out there completely out of touch with the reality of medicine. They're not even playing the same game.

I agree CAM is not science in the Platonic world of science and no-science.

But I would definitely be open to it in times when medical science is impotent.

Imagine you have a rare disease where life expectancy is poor, like an aggressive cancer. You've heard a cocktail of multiple chemo agents is best--but no doctor is willing to prescribe the drugs (fear of litigation). In fact, no company will let you participate in clinical trials with combo drugs (creates confounding variables).

You're stuck with a probably ineffective drug.

Would you be willing to try homeopathy? Would you drink up some wheat grass? Or try acupuncture? They are readily available and might help. Acupuncture might even improve your quality of life--probably important for what little you expect.

Science is the best knowledge to apply to all people. But that might not be good enough.

I'm also disappointed at your use of straw-man arguments, as well as convenient omission of any mention of harms that have been done under the auspices of science-based medicine. If you're going to attack the worst abuses in the system you oppose, you should at least recognize similar abuses in the system you support. Notwithstanding that portrayal of the opposing side, a surprising number of your assertions contain holes big enough to drive a truck through.


Presh proposes a useful hypothetical ("Imagine you have a rare disease where life expectancy is poor...You're stuck with a probably ineffective drug") then asks some commonly wondered, yet, IMO, silly, questions:
"Would you be willing to try homeopathy?" No. Why WOULD I try a completely ineffective drug rather than either nothing or the "probably ineffective" drug?

The "what if" question in this form is a part of the catechism of sCAM apologetics that seems to sway even those who are wary of woo. And it is bogus.

Common elements of the question:
it can't hurt,
it might help,
the doctors gave up

These memelets are sloppy, shallow, offensive to the intellect. I am particularly disgusted by the meme of the mean medicos, these mythical doctors who abandon their terminally ill patients. They are great fodder for melodrama, and as unrealistic as that other staple of urban lore and movies, the lone, mad scientist.

In twenty years of healthcare as worker, and 23 as a parent of a chronically ill, disabled child, I have yet to meet these imagined ogres. I am especially disgusted that people can think oncology team members "give up", "abandon", "do nothing for" their chronic or dying patients. Much of oncology has developed palliative treatments.

Presh writes: "Acupuncture might even improve your quality of life"
Maybe, a bit, but it seems to require both belief and punctures (the "acu-" part does not seem to be important to the efficacy) for best effect, and even that is minimal and short-term comfort.

I prefer drugs and such interventions that work on the chemico-physical thing I am, reliably, even when I am having a cranky, cynical day. I am, in the hypothetical, dying, after all, so I am likely to have some bluesy times. BTW, it is a relief to know I have some good research showing that cheerfulness does not improve survival. I always found an element of creepy coercion, blame-the-victim puritanism and infantilization in all the teddy bears and crayons and cloying pink ribbon cuteness.

A lot of surgery and chemo is about "quality of life" even though, somehow, the sCAMmers have planted the idea that such quality is their venue, even as they show vanishingly little evidence even for the palliation of placebo which they may provide. Perhaps only callous, selfish, smug thugs who try to peddle sCAM from the luxury of their temporary health can stand far enough away from real illness to maintain the mean doctor fantasy. When they do get sick, and they will, I hope they are releived not to have their notions validated.

Skeptyk: I am enjoying this discussion, so please let's continue a cordial debate.

1. You might not be willing to try alternative medicine. That's fine. But that's an individual decision I would like each patient to make.
2. Logically, we can only conclude "there is no evidence that alternative medicine works." This is vastly different than saying "the evidence says alternative medicine is ineffective."
3. I have personally heard a radiology oncologist tell a patient there are no more known treatments. The doctor did not "give up" but he was unaware of clinical trials and unable to recommend further treatment.
4. Economic considerations and imperfect knowledge should make us skeptical of science. For instance, trans fats were heralded by science as an alternative to the saturated fats of butter. Companies adopted it because it was cheaper and had more shelf life than butter. Of course, we know how that story ended.

By and large, I agree that I follow mainstream science. But I am glad we're testing alternative theories. This is what an empirical skeptic would do instead of relying on a Platonic infallibility of science.

I used to think that if i were diagnosed with a disease with certain fatality, I would be so desperate to try anything and everything, including CAM. However, the problem with CAM (and why its abolition is necessary) is that people dont turn to CAM as a last fact, they replace conventional medicine with it. Furthermore, the dissemination of CAM information dilutes out the information of true medicine that has been tested and works. As an anecdote, i struggled to convince several family members of the uselessness of several "supplements" that claimed to alleviate pain. While thats one example, it only takes one to make it unethical for CAM to prevent access to tested scientific medicine.

By cam equals scam (not verified) on 04 Feb 2008 #permalink

The idea that doctors never give up is completely ridiculous as is the idea that CAM is the only viable option in that case. None of this is as black and white as any of you seem to want. Does acupressure work? Yes, it's just massage for god's sake. Are there herbal treatments that are just as effective? Sometimes (white flower oil is just natural bengay and it smells better).

On this doctors are always persistent thing. Really? Where did you get that idea? Sure, they are overworked and incredibly busy, but that's not an excuse for saying they can't figure out what's wrong so everything is fine. I have spent months exhausted and in pain while doctor after doctor said "i don't know. maybe it's in your head." (No, it isn't, they're treating it. I'm fine now, but it took months.) Was I desperate enough to try CAM? Yup and it did help. Maybe ti was placebo or they just got lucky for a few hours, but when you are in constant pain, two hours relief is worth almost anything.

Don't call it science, but don't claim that you are better because you ridicule it and everyone who turns to CAM in desperation. I'd rather have EBM, but it failed miserably for long enough that imaginary options were better than giving up. Your contempt of people who are desperate just reflects badly on you, not them or CAM.

Presh Talwalkar,

I agree with most of your comments above, but not this:

Logically, we can only conclude "there is no evidence that alternative medicine works." This is vastly different than saying "the evidence says alternative medicine is ineffective."

As stated, this is false.

It's true for some alt meds, but not for many others. There are quite a few alt "meds" where the evidence says quite clearly that they don't work, and indeed, cannot work based on what we know of biology, chemistry, physics, etc. Yet alt med proponents continue to insist they do work.

Homeopathy, chelation for autism, colonic detoxifiers, magnetic bracelets, energized water, healing crystals - it's a pretty long list.

Even amongst herbal 'medicines' (where an actual effect is at least plausible), many times the evidence indicates they do not work as claimed. Yet how often do you see alt 'med' proponents admit that?

Evidence based medicine surely gets things wrong all too frequently, as your trans-fat example shows. The key difference, IMO, is that evidence based medicine generally admits its errors when the evidence requires.