A long time ago (in blog years) I wrote a series on alternative medicine over at my old WordPress blog. It's time to dust off the old post and get back to some basics.
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 so-called "mainstream" medicine is simply 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?
Don't stop now...you're on a roll!
As I get more and more questions, I realized that 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. That's real, science-based medicine, with real results.
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). That is the other side of the real medicine coin---if something doesn't work, we are forced to give it up.
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. But for some reason, they haven't been given up, despite their repeated failure.
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.
The alternative to science-based medicine? Well, I guess we'd have to call it "faith-based" in that faith is the only thing supporting its use.
So why do people keep relying on faith-based medicine?
I first 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. In doing so, I may have underestimated the religious and magical thinking that 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, irrational worship? It reminds me more than a little bit of the attraction people feel for creationism, despite the beautiful complexity of evolutionary theory.
But alternative medicines have been around for so long, and so many people use them!
Thank about that. Do you really want to entrust your health to "tradition"? What has this tradition actually accomplished? Has so-called traditional Chinese medicine eradicated any diseases? How about ayurvedic medicine? People in China and India with access seek out the same kind of care you would find in any large American hospital. They don't rely on thousand year-old systems based on imaginary ideas that were developed before we even knew what all that mushy stuff under the skin does.
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.
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. Patient's 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.