Yet another hat tip this morning to anjou, a regular reader, commenter, and human RSS feed on all things cancer and alternative medicine (not to mention turning me on to Vanessa Hidary, the "Hebrew Mamita" spoken-word artist).
Last night anjou brought to me a superb AP Impact article, Alternative medicine goes mainstream, from medical writer Marilynn Marchione. I know that AP has been skewered as of late by various science bloggers but this particular article by Marchione is one of the best treatments I have seen in the last two years regarding the truth behind the alternative medicine industry and its infiltration into academic medicine.
It's no surprise then that this article is being picked up extensively by US newspapers this morning.
[See also commentary from my academic physician-scientist colleague, Orac, at Respectful Insolence.]
We in academic medicine are complicit:
They are doing Reiki therapy, which claims to heal through invisible energy fields. The anesthesia chief, Dr. Richard Dutton, calls it "mystical mumbo jumbo." Still, he's a fan.
"It's self-hypnosis" that can help patients relax, he said. "If you tell yourself you have less pain, you actually do have less pain."
Like "Big Pharma," there really is such an industry as "Big Woo" that co-opts a little science with classic marketing techniques:
"Herbals are medicines," with good and bad effects, said Bruce Silverglade of the consumer group Center for Science in the Public Interest.
Contrary to their little-guy image, many of these products are made by big businesses. Ingredients and their countries of origin are a mystery to consumers. They are marketed in ways that manipulate emotions, just like ads for hot cars and cool clothes. Some make claims that average people can't parse as proof of effectiveness or blather, like "restores cell-to-cell communication."
"An Associated Press review of dozens of studies and interviews with more than 100 sources found an underground medical system operating in plain sight, with a different standard than the rest of medical care, and millions of people using it on blind faith."
And while I have long held that alternative medicine is something that must be taught to future physicians and pharmacists (as I have done for 14 years), my critical approach is neutralized by something that I have seen firsthand at several major academic medical centers: the role of philanthropists and advocates in influencing the medical school curriculum:
Some medical schools are teaching future doctors about alternative medicine, sometimes with federal grants. The goal is educating them about what patients are using so they can give evidence-based, nonjudgmental care. But some schools have ties to alternative medicine practitioners and advocates. A University of Minnesota program lets students study nontraditional healing methods at a center in Hawaii supported by a philanthropist fan of such care, though students pay their own travel and living expenses. A private foundation that wants wider inclusion of nontraditional methods sponsors fellowships for hands-on experience at the University of Arizona's Program in Integrative Medicine, headed by well-known advocate Dr. Andrew Weil.
The reason I think that alternative medicine must be taught in academic health professions program is that the more we understand and can speak to patients with non-judgmental authority on these topics, the greater chance there is that patients will choose modalities that will provide them the most benefit - so I am encouraged by this quote from Mitch Gaynor:
That is why Dr. Mitchell Gaynor, a cancer specialist at the Weill-Cornell Medical Center in New York, said he includes nutrition testing and counseling, meditation and relaxation techniques in his treatment, though not everyone would agree with some of the things he recommends.
"You do have people who will say 'chemotherapy is just poison,'" said Gaynor, who tells them he doesn't agree. He'll say: "Cancer takes decades to develop, so you're not going to be able to think that all of a sudden you're going to change your diet or do meditation (and cure it). You need to treat it medically. You can still do things to make your diet better. You can still do meditation to reduce your stress."
Once their fears and feelings are acknowledged, most patients "will do the right thing, do everything they can to save their life," Gaynor said.
In light of this quote, it's interesting to read the closing of an Archives of Internal Medicine review that a certain science blogger wrote with a chief medical resident 11 years ago:
Classically trained physicians cannot ignore herbal medicines anymore. We must realize that patients are using herbal medicines, and insurance companies are beginning to cover the costs and are even asking us to oversee the use of herbs in certain situations. We must all become educated about these products, and at the very least know where to find information when we need it.
Asking patients about supplement use during the initial history is thus imperative. Patient disclosure of herb use may provide an opportunity for the physician to redirect the patient toward effective conventional health care. By taking a complete drug and supplement history, a dialogue can be initiated to rationally compare the appropriateness of herbal remedies and regulated pharmaceuticals in relation to the severity of the condition. Until herbs in this country are more strictly regulated, however, no classically trained physician should recommend an herbal product to a patient. For the herb-using patient who views conventional medicine with ambivalence, the physician can foster a more open and communicative relationship by demonstrating an objective understanding of both alternative and conventional approaches. [emphasis mine]
But I digress.
So I don't run afoul of AP, go and read Marchione's article yourself. She does an exceptional job near the end of explaining to critics that conventional medicine and pharmaceuticals have brought us debacles such as Vioxx and its cover-up, "The safety net for alternative medicine is far flimsier."
There something in Marchione's article for every blogger who writes about alternative medicine.
Readers: go forth and read. . .and thank you Ms. Marchione and colleagues for this superb report.
Good post-- hmm, that certain science blogger who wrote the article you linked to was ahead of his time, but at our house, we knew that!
What most people forget is that, according to the Eisenburg study out of Harverd, the use of alternative medicine is market driven, NOT research driven. People spend their money where they perceive value. We have spent trillions on "health care" for very little perceived benefit and one of the lowest rankings in health indices of a developed nation. Academic medicine is not "tolerating" anything. It is being dragged willy-nilly by market forces it can't control. If a profession complains and nobody hears it, are they relevant?
Alternative medicine, herbals, acupuncture, the placebo effect is alive and infiltrating academic medicine. Another proof positive that Michael Shermer's patternicity can be counted upon to let folk science rear its ugly head.
Not only is mysticism driven by the market, it can also be hugely driven by popular opinion. Addiction is a serious problem in need of real answers, however the main treatment in the U.S. is the 12 step program and AA. Further, if a patient goes into treatment they are generally taught a few coping skills and directed to attend AA meetings. The whole "disease" concept that is currently in vogue and supported by the AMA was created by AA. The system is based on Buchmanism which was an attempt to unify all Christian religions with the founder believing in a benevolent dictator. (He supported Hitler). The whole of treatment in AA is a belief that a Higher Power can cure/treat/ stop a behavior the individual(who is labeled powerless cannot. Recovering folks are then to believe a miracle has occured for which they are not responsible. If they fail, it is their lack of faith. If they succeed, it has nothing to do with them...it is God.
My point is that if you are using self hypnosis and it helps, that is a good thing. If you believe your lucky rabbits foot cured you, that is okay as well. These things become a problem when such folks become proactive charging big bucks for lucky rabbit feet, or attempting to force others to buy lucky rabbit feet. In the U.S. the entire recovery industry is essentially nothing more than a market for AA lucky rabbit feet. If a person is cured, and they believe, that is fine, but if a person has any sort of critical thinking skills or analytical process, even if they have faith they can find themselves in the cold.
#5, if you believe your rabbit's foot cured you, that's a problem. You'll take actions based on this false premise that will lead to great harm. Like, for example, insisting that your children be treated with the severed feet of fluffy rodents, rather than with real medicine.
It doesn't matter if it makes you feel better. The small statistical skewing of the placebo effect is not worth the larger consequences of fuzzying up the way people view medicine. The medical community should be relentless and merciless in its condemnation of treatments which are not approached via the modern medical method - that is, the scientific method as it applies to medicine.
#6: I agree the scientific method is the best. I also take things to their logical conclusion. I'm largely a frustrated scientist/researcher and realize the value of those things. Therefore, I agree with your criticism. I see the logical conclusion. My observation, however, has been that most people aren't logical at all. They will explain their thirty years of non-heroin use as a miracle from God, but be unable to explain why God won't miraculously cure childhood onset leukemia. Further, if they develop a genuine illness like cancer, they might pray, but they will also be running to get chemo. Again, most folks aren't strictly logical and seem to draw a line that will most likely gain social support as well as long term survival.
Quite a lot of conventional medicine isn't based on rigorous science, either. Pharmacology is bad enough, but the situation with surgery is simply absurd - and the lag time between research findings and adoption and use of the information in practice is unacceptable.
Market forces are one of the few things powerful enough to get doctors to change themselves. If people are turning away from "the best option" in droves, perhaps doctors should re-evaluate whether they're as useful as they believe themselves to be - and why so many don't agree with them.
Wow, that AIM article is great. I have two small nits to pick (it's what I do, I used to raise body lice, in the lab ... not on me). On the third page, it suggests that the FDA "created" the DSHEA. Actually, that was the fault of politicians who wanted to hobble the FDA. Also, the Eisenberg data is dubious http://www.quackwatch.org/11Ind/eisenberg.html It seems that if one compares the health concerns (e.g., "back problems") mentioned by a percentage of respondents to the survey vs. CDC percentages for the same complaints, the survey is not representative of the general population.
Neither of my observations detracts from the science discussed in the article.
I find it interesting that intelligent bloggers like yourselves would support such a broken system as the current vetting process for "Modern Medicine" via the FDA and hold that up as the Gold Standard for care.
Apparently anyone with enough money can get something cleared for some niche use and then market it fraudulently for off books uses with close to zero liability.
The problem is not with alternative medicine causing harm, because really, when was the last time you heard about a multi-billion dollar lawsuit against supplement makers? They have money, if a lawyer could go after them I am sure they would.
The problem is that the so called safety and science behind these medicines is a crock. Anyone with a rudimentary knowledge of Google can find all sorts of consistent complaints of side effects about everything from Birth Control to Statin Drugs.
In the information age we are no longer blind to these real dangers and are using the internet as a source of information to make informed choices about our health care.
So the answer is simple: people are choosing alternative treatments because they are afraid of the mainstream alternative. The mainstream alternative can clean up its act any time it likes if it would start focusing on common sense solutions instead of symptom masking profits. Figure out how to make money with a cure and you've won yourself a Nobel prize in my book.