The Problem With Alternative Medicine

Americans spend an astounding thirty-four billion dollars on alternative medicine annually.  Given that so many of us put our faith in alternative care, I wanted to clear up some common misconceptions about it to help people make wiser choices when and if they turn to it.

WHAT IS “ALTERNATIVE” MEDICINE

In general, alternative medicine is used to describe practices outside the bounds of conventional medicine.  It’s also often connoted to include practices that haven’t been shown to be effective.  Mainstream scientists often criticize alternative medicine as charlatanism, arguing that anything alternative that’s been proven to work is in fact…mainstream medicine.  Advocates of alternative medicine, in contrast, typically point to their personal experiences as proof of the effectiveness of many such “unproven” interventions.

Many people feel more comfortable using natural compounds rather than man-made ones because of a belief that what’s natural is, by definition, healthier and safer—but this is a dangerous assumption.  Numerous natural compounds are, in fact, poisonous (e.g., cyanide).  And natural compounds that have health benefits often have a narrow therapeutic index (meaning the amount that brings benefit is only slightly less than the amount that causes toxicity, making it alarmingly easy for their use to cause harm), like digitalis, a drug derived from the foxglove plant that’s been used to treat heart failure since the late 1700s.

Many patients tell me they “don’t like to take pills” but paradoxically think nothing of ingesting “natural” herbs or plants.  This distinction has always struck me as absurd.  Both man-made and natural compounds have effects on biological systems.  Nothing about natural compounds makes them more or less effective or safe.  How confident we can be that a given compound is both effective and safe has nothing to do with where it comes from but rather with how rigorously its effectiveness and safety have been studied.

This, then, is the main problem I have with alternative medicine, that in general its interventions haven’t been subject to rigorous study.  I’m open to believing anything, no matter how far-fetched it may seem (after all, who would have believed that television would be possible five hundred years ago?).  I don’t even need to know an intervention’s mechanism of action.  I just need to know that in well-designed studies it’s been proven effective.

And safe.  Prima non nocere:  first, do no harm—medicine’s most important credo.  When you’re the one with the authority to recommend treatments, you take very seriously the possibility that what you recommend may cause harm.  I’m even open to the use of interventions that haven’t been proven ineffective as long as there’s reason to believe they’re safe.

But safety is a tricky thing.  First, it never exists as an absolute.  That is, an intervention can be safe for some people but deadly to others (e.g., penicillin is safe for almost everyone who takes it—except for those who are severely allergic).  Further, “safe” is often a value judgment that varies from person to person and for one person from situation to situation.  We may think it obvious that anything with a risk of death isn’t safe—but then again, what if that risk of death is less than 1% and we’re talking about performing a cardiac catheterization in a patient who’s just had a heart attack?

Alternative medicine enthusiasts often point to centuries of use to justify their belief in the safety of many alternative medicine practices (if acupuncture kills or maims, why hasn’t it been reported?), but without carefully designed studies, how do we know, for example, that black cohosh doesn’t increase the risk of auto-immune diseases like lupus?  Certainly, numerous examples exist in which man-made compounds were subject to rigorous study in clinical trials, labeled acceptably safe, and then later discovered not to be (remember phen-fen?).  But this is the exception rather than the rule.

DO ALTERNATIVE THERAPIES WORK?

Interestingly, as more and more studies of alternative therapies are being conducted, we’re discovering that many of them do work—but not necessarily for the things people believe.  Acupuncture, for example, has been suggested to be effective in reducing the nausea associated with chemotherapy.  But trials also show for back pain there’s a good chance it’s no better than placebo.

On the other hand, even when clinical trials show an intervention works, it still may not.  Some kinds of experimental designs inherently produce less convincing results than others.  And even double-blind, prospective, randomized, placebo-controlled trials—the gold standard of clinical trial design—often turn out to contain flaws, even those published in well-respected scientific journals.  Often these flaws are small enough not to impact the validity of results—but sometimes they do.  This is why treatments must often be studied multiple times in multiple ways before they gain acceptance in the scientific community.

People turn to alternative therapies for many reasons.  Perhaps because of a bad experience with traditional medicine.  Perhaps because personal experience strongly suggests they work (when my wife was pregnant with our son and feeling intense nausea, I tried applying pressure to her wrist at a standard “acupressure” site and was astounded to hear her say, repeatedly, the nausea vanished when I pressed and returned when I released).  Perhaps because traditional medicine has no more to offer.  Especially when the diagnosis is terminal, what’s to lose?

If you’re going to go the alternative route, do as much research as you can.  Look for treatments that have been shown in some kind of study or studies not to cause significant harm.  Look for treatments that at least have some anecdotal reports of success for the specific problem you have.  (And I don’t mean reports offered by people selling alternative interventions.  Though many, if not most, alternative medicine practitioners are genuinely interested in helping others and believe in the effectiveness of the therapies they offer, snake-oil salesmen abound.  Beware overconfident statements about efficacy.  Remain suspicious about any claims that a given intervention treats or cures a multitude of disparate conditions.)

Traditional treatments aren’t inherently superior to alternative ones—they’re just better studied.  Which doesn’t mean that they’re effective or safe beyond any doubt—just that they’re more likely to be.  The praises we should be singing aren’t to any one specific intervention, traditional or alternative, but to the scientific method itself, a way of making valid observations about cause and effect in the phenomenal world.  It’s both a lot harder to do well than many of its proponents understand, yet simultaneously a far more valid means of assessing efficacy than anecdotal reports and length of use could ever be.

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26 comments to The Problem With Alternative Medicine

  • Thank you for this excellent post. We live in Mexico near the capital of the state of Veracruz, Xalapa. It is a pretty “modern” area which has very few foreigners. There is excellent medical care here. In our area, the people who tend to polarize medicine into traditional (always called allopathic) and alternative (called a variety of things) tend to be some of the very few foreigners who live here. They tend to be (rigid) followers of homeopathy. Some of them have sometimes adopted what they think are “traditional” or old indigenous practices. Among Mexicans, the divide is very blurry indeed, but not so that “allopathic” medicine suffers. Among educated people, there are “cures” everyone uses including, for instance, a bougainvillea-based tea for coughs, a homeopathic medicine that seems to calm dogs, and various end-of-life efforts that are soothing after allopathic medicine no longer seems to comfort. One pediatrician sends some of her asthma patients to a homeopath because the homeopath is effective for “who knows what reason.” Among poor people, traditional herbal cures are use very frequently because they are what people can afford. Thus people go to local hueseros—sort of chiropractors—and herbalists of various sorts. I should add that homeopathy is fairly respectable in Mexico and there is a state-funded school. A friend of ours, a veterinarian, says he thinks they can be effective for some things because they learn so much about the patient. He says a good homeopath would always send a patient to an allopath for things the homeopath couldn’t treat.

    We have a standard physician, an excellent internist. He has definitely not recommended strange treatments, but he, too, depends on spending time with his patients and getting to know them. His exams are very much “hands-on.”

    None of the physicians I know oppose valid means of assessing efficacy and in fact are extremely knowledgeable about what they use. I think one problem in the US is the failure to broaden the picture: patients tend to see one or the other, traditional or alternative, black or white. So what’s really missing from the picture? At least some people are searching for the human connection which we do find here. They mistakenly think somehow that alternative medicines have more “soul” if you will.

    Myra Zilberger, a physician-researcher has some excellent blog posts clarifying some of the issues which have driven both physicians and non-physicians into their respective corners. This is the latest one: http://evimedgroup.blogspot.com/2010/08/allopathic-medicine-and-cam.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+HealthcareEtc+(Healthcare,+etc. The three previous ones are also excellent. She is much clearer about this stuff than I could hope to be.

    Once again, I thank you for your excellent post which also serves to try to heal the rift. I tend to be awfully USA-traditional and look for “allopathic” physicians all the way, but Mexico has softened my outlook and has also showed me the tremendous importance of the art side, the human side, of physician-patient relationships.

  • Kathy

    Western medicine has all the same drawbacks, in my humble opinion.

    Look how many drugs, after being “approved” by the FDA, then later need to be recalled and do serious damage to those who put their faith in their doctor. The makers of these drugs are the modern snake-oil salesmen—it’s appalling to watch the evening news and see how they are pushed on us, the way they are advertised is phony, and not in people’s best interests (Viagra, once-a-month drugs, steroid drugs, and so many more). Yes, it’s my humble opinion, but I feel they do more harm than good. I do like your weekly email, and agree with most of what you share with your readers.

  • Nathan Clark

    In relieving your wife’s nausea during pregnancy, the “human factor” may have been more effective than either of you realized because you touched her. Human touch (mother/baby, nurse/patient, lover/lover, etc.) is well known to calm and relax stressed individuals.

    Nathan: In this case, I don’t think so. When I’d press even a finger’s-breadth away from a specific point on her wrist, she’d have no relief whatsoever. It only worked in one specific area. I have no idea how—I’m extremely skeptical about any meridian or energy line explanation—but it was a reproducibly observable effect with a placebo test (even if done on only one person).

    Alex

  • Emily

    This is a great post, I could hardly have said it better myself!

    A lot of people who praise alternative medicine seem to think man-made chemicals are inherently dangerous. As a scientist, it maddens me to hear things like that. Because of course, natural or man-made, *everything* is a chemical! What’s even worse is that they’re not thinking about the mechanism in which something may be good or bad, but rather they just believe it to be true. I swear, it’s a slippery slope and pretty soon you’ve got guys in the check out line at the natural foods store who make the cashier type in each bar code because he believes the scanner poisons his food (true story).

    But the really important point is that anecdotes are not evidence (so few people understand that), and that using the scientific method is really the only tool we’ve got to understand the benefits and risks of treatments.

  • Alex,

    An interesting post, and an area that I am personally delving into at the moment to try to assist my wife. I found this statement you made rather fascinating (and am not sure the point you were trying to make):

    “Perhaps because personal experience strongly suggests they work (when my wife was pregnant with our son and feeling intense nausea, I tried applying pressure to her wrist at a standard “acupressure” site and was astounded to hear her say, repeatedly, the nausea vanished when I pressed and returned when I released).”

    Astounded as in “there must be something to these reports of acupressure points, and their underlying meridian-based energy paths” or astounded as in “wow, this placebo effect is really amazing”?

    I myself am a Western-schooled hard-science graduate that has worked in a traditional technical field all of my adult life. I am supportive of the scientific method of investigation. But I also think there is a lot we still do not understand about how the universe really works. I think of the amazing experiments that proved “spooky at a distance” entanglement between particles, for which Einstein himself designed the experiment (since he could not believe it to be true) and then after his death, was indeed proven so.

    I also think the human body is truly amazing product of millions of years of evolution, and suspect there is an awful lot we don’t understand about how it operates. Is there some reason that use of that acupressure point quelled your wife’s nausea? I suspect that there is, beyond any sort of placebo effect. Do we in Western science understand the root cause of why that happened? Apparently not, and I wonder if we are using the correct paradigm at present to understand it.

    Steven: I was astounded not that there must be something to “meridian-based energy paths” as nothing I did explained the reason what I did worked, but rather to find there was something to the reports of acupressure points at all. As I noted in an earlier comment, I don’t think it was a placebo effect.

    Also, every effect (including, incidentally, the placebo effect) has a cause. If it is observable, the scientific method can identify it (as you know, it’s simply a specific, controlled way to ask answerable questions). But as I also point out in the post, we don’t need to know how something works to prove that it works.

    Alex

  • rdp

    ” The praises we should be singing aren’t to any one specific intervention, traditional or alternative, but to the scientific method itself, a way of making valid observations about cause and effect in the phenomenal world.”

    This, I think, is the most important concept to be taken from your essay, Alex.

    So far, however, we have placed many obstacles in the way of applying the scientific method to techniques/treatments that don’t arise from our own traditions. First, we have a strong bias in favor of things we DO TO a patient as opposed to things a patient’s own mind/body system can be prompted to do. We tend to discredit results for which we (or things we understand) are not the agent and credit very small results if we believe in the pathway of agency that produces them. When we hear of results from something we don’t understand, our first reaction is to denigrate it as “all in the head,” rather than to ask “I wonder how that might work?” Another major obstacle is that our medical system has been “corporatized,” by which I mean we find the motive for profit operating at nearly every stage. Few treatments will be tested scientifically (which is expensive) if there is no money to be made from their application. (Parenthetically, I am curious whether much time and effort are spent studying so-called spontaneous remissions of serious diseases. Do you know?)

    The First Do No Harm dictum would seem to suggest we start with the minimally invasive approaches first and move toward medications/surgery, etc. if we see no results. But this tends not to be what happens. When I was hospitalized for severe nausea in pregnancy, I got phenergan, which made me feel dreadful and caused a kind of repetitive startle reflex; no one even tried pressure points! In just about every medical situation I have had experience with, medication has been the first—or only—treatment offered.

    The suggestions you make for anyone considering alternative medicine seem wise for those who go the traditional medicine route, as well. The problem is that it is exhausting and easily becomes a full-time job!

    BTW, by coincidence, a friend recently forwarded me a podcast dealing with the placebo effect you may find of interest. You can find it here. http://www.radiolab.org/2007/may/17/

    rdp: In your first sentence you put your finger on the reason I wrote this post. I agree with the points you make about the obstacles we place in the way of applying the scientific method (and wrote about it in some length in When Doctors Don’t Know What’s Wrong).

    Alex

  • Melissa

    Alex,

    Thanks for delving into this topic. As we discuss this, a new condition called sarcopenia has been named and defined by the modern medical/pharmaceutical establishment (it’s impossible to see the two as distinct at this point). Sarcopenia is a condition of muscle loss, as in the kind we experience with age but also as a result of intense treatments like chemotherapy. For the latter condition, I would agree with the need for drug intervention if it’s shown to be safe and effective. For the former, I think it’s ridiculous.

    As a massage therapist, I’ve felt all manner of muscle tissue, and the single most common “condition” I confront with my clients is muscle weakness. The solution is exercise and good nutrition, not a pill or a shot. In some ways, exerting a sore muscle seems counter-intuitive. Because such exertion can be unpleasant, individuals tend to have to force themselves to do it…or avoid it altogether. In the face of this, it’s much easier to take a pill, and it’s exactly this pandering to the lowest common denominator of human tendencies that frustrates me with allopathic medicine.

    In response to a previous submission—maybe allopathic doctors take seriously their authority to dispense treatments. Maybe they do. Or maybe they take their authority completely for granted because we as patients have become so passive in our approach to taking care of our bodies.

    Within the scope of my practice, I have no doubt that my work helps people, and it does so with virtually no negative side effects. I can’t tell you entirely how it works, but as massage and other “alternative” therapies continue to build their professional standards and organizations while continuing to generate serious revenue, it’s likely more research will follow.

  • Janice

    No one can deny the many miracles of US modern medicine, but I believe the skepticism of the “alternative” camp is based in part upon the drug companies’ stranglehold on traditional medicine, which doesn’t allow for too much “cross pollination,” if you will, between “traditional” and “alternative” therapies. I have known in my life two alternative practitioners, one a physician (an MD), the other a veterinarian (DVM), both trained at prestigious US schools (and prestigious Chinese institutions) who wanted to offer the best of both worlds to their patients. And this was 30 years ago! Without real societal and economic support for effective preventative and non-drug interventions, alternative therapies will continue to be treated with derision by the “better living through chemistry” camp on the one hand, and [perhaps] overly embraced by the “other side” who feel they are being treated like 3rd world citizens by mainstream practitioners. The same caveats should apply when seeking out any type of treatment or practitioner, as bad doctors and bad medicine exist on both sides.

  • Actually a lot of people do understand that anecdotes are not evidence, although that’s not really true either. Case studies and qualitative studies can be the stepping stones to larger studies. Even more important, they provide evidence for that particular case. That is, if something works, and works repeatedly for an individual, it works in that limited context. On the other hand, large studies are only truly applicable to groups; they don’t speak to the individual. A doctor should certainly try meds that have been shown effective in large studies, but he shouldn’t try them, for instance, with patients who have idiosyncratic contraindications, whether they be physical, cultural, psychological, whatever. This is where the physician should differ from the researcher. She should know her patients as individuals and be able to evaluate the larger studies on the one hand while considering the patient on the other.

    It’s important not to turn the scientific method into a religious procedure. Scientific method can lead people astray. Scientific method is good for a particular sort of data testing. It’s also very important to be able to see what was NOT included in studies when evaluating the conclusion.

    Esther Buddenhagen

  • Leigh Capone

    Alex,
    Thank you for the important post. Personally, I believe that a mixture of “alternative” and traditional medicine is the preferable approach. However, these days with the unending television commercials for drugs, I find myself more skeptical of traditional medicine or at least the pharmaceutical industry. I have experienced more than once the feeling of being over-prescribed medicines too quickly by traditional doctors—even being told that a certain antibiotic “had no side effects,” which of course cannot be said of anything and had terrible side effects for me. When it comes to veterinary medicine, I have seen a similar approach. When my elderly cat’s health began declining, traditional vets suggested everything from massive steroids to leg amputation. After having her treated by a reputable homeopathic doctor, her symptoms evaporated and she lived a healthy two more years. This is not to say that I have not seen the incredible wonders that traditional medicine can accomplish—including successfully taking on my mother’s lymphoma—it’s just that in an age where a lot of people would rather take diabetes drugs instead of losing weight and seeing if their condition might resolve or would rather take cholesterol medicine along with large servings of red meat and brie instead of modifying their diet—something seems dangerously out of balance.

  • Diana

    For several years, I noticed that my 3rd, 4th and 5th left toes had absolutely no feeling. Then when the numbness appeared in my right foot, in 2007, fortunately I was seeing a primary care physician who referred me to a neurologist. I have neuropathy. At the same time, I learned that an acquaintance’s husband was opening an acupuncture clinic. I began going and still do—I now have feeling in all my toes, though there is still slight numbness. The neurologist couldn’t find a cause—I fit in the “black hole” of neuropathy. Actually it’s genetic. My oldest sister can’t feel her shoes and my dad also had it (he also had polio). I continue to see the acupuncturist for the neuropathy and the Chronic Fatigue Syndrome symptoms. I also see my primary care physician and a rheumatologist. I try everything—alternative and regular medicine. Right now, after watching a CFIDS webinar last week and discovering I also have orthostatic intolerance, I’m on a new medication and also using a support garment. From 2004 to last year, I saw a primary care physician who also has a lab studying CFS. He was very helpful, but expensive, and suggested many medications that had side effects. I had to stop one med because it affected my liver. The last one required visits to an eye doctor because it could affect vision. I am open to all suggestions.

  • Tara

    I prefer to use a combination of allopathic and homeopathic treatments, it seems to give me the best of both worlds and the most success.

    Being too dogmatically committed to one method or the other is unwise, I think. Both traditional and alternative medicines have something to offer us.

  • anne

    It seems to me that besides the differences between allopathic and naturopathic/alternative medicine, there is a difference between “medicine” and “healing.” “Medicine” is what is done externally to the physical body, and “healing” encompasses whatever is needed to heal a hurt or ill person, including physical treatments and repairs, mind and heart therapies, and even the way we interact with each other and the world around us. “Healing” is something both allopathic and alternative medicine are part of. Both forms of medicine can be harmful or helpful, depending on how they are used.

  • Greg

    As someone who had put my faith in so-called alternative medicine and had suffered great harm (a missed diagnosis of leukemia), I can understand the frustration doctors and scientists have with alternative medicine. Really, the dichotomy is between science-based medicine and non-science based medicine. Both allopathic and so-called alternative medicine have both, but really it’s allopathic that is taking the initiative to look for evidence behind what they do. Alternative medicine fights scientific evidence tooth and nail, every chance it gets (just look at the MMR vaccine “debate” and you’ll see what I mean).

    I think one of the differences in attitudes that divide allopathic vs. alternative medicine is a natural human discomfort with uncertainty. Science-based medicine is comfortable with uncertainty—the basic assumption is that nothing is known a priori, so any course of action should be based on a review of tested and reproducible evidence. There is an elegance to a disciplined scientist admitting that they don’t know the answers from the start, but he/she is on a never-ending journey to learn and explore. Alternative medicine, in contrast, assumes a given narrative to be true (meridians/chakras, for example), and any evidence that is gathered which is seen to be contrary is dismissed outright (often as part of some conspiracy of big-pharma or something).

    In my own experience as a patient dealing with attitudes from my alternative medicine providers, I’ve found an analogous situation to challenges in evolution research—creationists and intelligent design people believe in a certain narrative for the existence of the universe, which was fine 200 years ago when we didn’t have any other guidance to base our opinions on but certain religious texts. However, since then, science has come up with further evidence for an extensively validated theory of evolution and natural selection, spanning such diverse fields as genetics, paleontology, geology, astronomy, archeology, psychology, etc. But despite these radical changes in understanding, the resolve that new-earth folks have to believe in their previously acknowledged narrative only hardens when exposed to contrary evidence. What happens next? Just look at the Kansas school board debacle (and weep). It’s troubling to see this happen in medicine as well.

  • Sachiko

    How ironic! I was reading a journal article yesterday on medicinal plants in therapy, which talks more about this particular topic.

    Craker, LE and Gardner, ZE (2006) Medicinal Plants and Tomorrow’s Pharmacy, An American perspective, R.J. Bogers, L.E. Craker and D. Lange (eds.), Medicinal and Aromatic Plants, 29-41.

    It is an interesting read :)

    I believe that medicinal plants and natural remedies DO have a place in therapy, but studies ought to be conducted and research performed to ensure their safety and efficacy.

    I am from Sri Lanka, and people here heavily rely on traditional medicine (ayurveda) to cure ailments. These plants have been used for decades and decades, but not many scientific studies have been conducted proving their effects. However, people here use and trust these products more than conventional medicines. I am currently doing research, trying to find scientific proof for some commonly used traditional plants, because it is important to have facts to back faith.

    I am currently doing research on medicinal plants that have anti-inflammatory activity.

  • Always a hot topic. I look forward to your follow up post, “The Problem With Conventional Medicine.”

    Beno: Ha! I probably should have titled this one “The Problem With Medicine” as I ended up going after both a little bit.

    Alex

  • Good post. Many want to seek alternative therapies, but don’t know where to start. Your advice is sound.

  • Lorna

    I find both approaches are useful. For example, in treating migraines, my doctor has successfully helped me find a medicine to eliminate symptoms. Alternative medicine practitioners are usually more affordable, and I can pay for the time necessary to troubleshoot migraine triggers, soothe tension, and help me see lifestyle changes that might make a difference. There is so much reliable information available for informed patients now that it’s easier to make safe decisions about alternative care.

  • Barbara Saunders

    I used to work for an alternative medicine clinic (acupuncture and herbs) for pets. The conclusion I came to was that a lot of people aren’t really seeking different medical interventions. What they want is a different relationship with their medical provider. In the veterinary world, acupuncture practitioners must be licensed; Western vets, too. Many people were drawn to the hour-long appointment that enabled them to discuss their pets’ entire life rather than to the standard 15-minute consult.

    Barbara: That’s a really insightful point.

    Alex

  • This is an interesting subject to me, and thank you for a rich and chewy post about this. I believe that part of the problem is the somewhat arbitrary (at times) divide between what is considered “conventional” and what is considered “alternative.” As you point out, in general, alternative medicine is used to describe practices outside the bounds of conventional medicine. It’s also often connoted to include practices that haven’t been shown to be effective. But many modalities that used to be considered “alternative” are gaining acceptance as studies are showing efficacy. For example, there are many wonderful integrative cancer clinics around the country that use guided imagery, nutrition, massage, and other therapies alongside chemotherapy, surgery, and radiation, because studies are showing many of these therapies to be useful. I think there may be a third category that lives somewhere in the middle of conventional vs. alternative. We might call that third category “integrative” or “complementary care”… but increasingly there are treatments that are gaining popularity precisely because the science is good and (not to sound cynical but this is also an important factor) insurance companies are increasingly covering these treatments.

    I work in the field of complementary care—I am a nutritionist who also does guided imagery and wellness counseling. Many of us do stay abreast of current research, base our therapies on credible and scientifically sound approaches, and are able to work side by side with conventional medicine. And yet, much of what I do could be “mistaken” for alternative medicine.

    Another point I did want to bring up is the challenge in getting certain types of treatments researched. Again, at the risk of sounding cynical, there is less funding for research into many of the complementary and alternative therapies, because one cannot patent an herb and therefore a company doesn’t stand to make as much money from proving the efficacy of plant medicines as it would from proving the efficacy of a patent-able medicine. There are market factors that cannot be underestimated. Obviously if a therapy has been researched and found to be harmful, this is a different story. But I believe many therapies don’t get studied (or don’t get adequately studied) because there isn’t as significant a financial incentive to get good studies done.

    One more thing—have you read the book Narrative Medicine: The Use of History and Story in the Healing Process by Dr. Lewis Mehl-Madrona? Dr. Mehl-Madrona worked as an emergency room psychiatric physician for 20+ years. The book is on the importance of meeting patients in *their* belief systems, and how to use a patient’s beliefs to more effectively bring them to health. I find his work helps me to provide context and meet patients where they’re at in a way that is compassionate and effective, and helps me to get buy-in from patients even when my belief of what will help them differs from theirs. His website can be found at http://www.mehl-madrona.com/.

    Cheers,
    Bari Mandelbaum, CHN, NC

    Bari: You raise many excellent points, especially the one about market forces having their influence on what gets studied. Unfortunately, I have to agree with you there.

    Alex

  • All natural medicines need nature (water, sun, wind, soil) and the supreme spiritual…as a source of movement or life…without life there is no man, animal, or plant…so although we can predict what kind of pain or weakness our health, without soul or spirit we cannot live. We cannot be in the good health…because almost the 60% of mental and spiritual health assures the condition of our health…less than 60%, usually we will fall to pain or sick.

  • miriam

    Something I read recently said that there was no such thing as alternative medicine. There was only medicine that works and medicine that does not work. I think that is always the thing to keep in mind when discussing alternative or allopathic medicine.

  • David B. Hutchings

    Spoken like a true MD and AMA member. DO NO HARM, ha. You say a lot when you explain that you need to know it has been tested. That the results have been qualified by a system that you are part of and support. A system that supports you in your efforts. We know your job is overwhelming. Doctors struggle with the unknown because it is the bigger part of your day. Just getting the body to perform its own miracles is tough. So wanting someone to “COVER YOUR BACK” is very understandable. But this behavior does not support your DO NO HARM. It supports your position as an MD.

    Lastly I understand some of my feelings on this matter come from “Why We Need to Know Why.” I feel justified in my suspicions and distrust after reading your posts. It all goes along with the whole approach of western medicine. TO MAKE MONEY. What happened to the customer is always right? They used to be the reason. Now more a means to an end.

    Thanks for letting me run on a bit. And thanks for listening. Both do wonders in relationship development.

    David

  • David B. Hutchings

    PS.

    Thank you Bari for your comments. Thank you for stating them in a positive and professional manner. You have obviously spent the time and effort. Keep up your good works.

  • helensmom

    Alex,

    Just had to comment about the anecdote regarding helping your wife’s nausea by pressing on a particular point along her wrist. A medical device was developed, called the ReliefBand, that works to alleviate motion sickness by sending an electrical pulse along this very pathway—supposedly the pathway of the vagus nerve—to interrupt electrical signals sent to the brain that “complete” with the messages involved in transmitting the signals for the nausea, dizziness, etc associated with motion sickness. All I know is the ReliefBand works incredibly well for me for seasickness, making it possible for me to do things like take week long boat trips. And apparently for others for morning sickness and chemo related nausea. No mysterious energy meridians—or maybe the real explanation is the “energy meridian” is really describing the “information highway” of the nervous system (via the vagus nerve) that things like motion sickness, morning sickness, etc., take.

  • Skeptic West

    You hit all the major points. But I feel there’s one thing you didn’t talk about which I want to point out. That is, how a priori plausibility effects the way we judge clinical outcomes.

    One of the issues with clinical trials is that no matter how rigorous they are there will always be a great deal of noise in the data (due to the complexity of human systems, what is being measured, limited sample size, etc). Therefore we need to include the a priori plausibility of therapies when judging their true efficacy.

    Given the almost inescapable *positive* bias, in that if we are looking for efficacy we’ll more likely to find it rather than not, therapies that are actually ineffective are likely to be found effective. One way to combat this is to measure the plausibility of the therapy, and combine it with the results of the particular clinical trial. Homeopathy is a great example. In light of the deep scientific implausibility (chemistry, physics, biochemistry, pharmacology, disease etiology)—any positive clinical trials (of which there are many) are more likely representative of methodological errors and confirmation biases than they are of efficacy.

    That’s why many scientists are dismissive even when research of alternative medical therapies come out positive—even when they sometimes match the positive effects of drugs. It’s because there is often (not always) basic science that supports the drug’s efficacy and safety which *increases our confidence* in any minor clinical effects we observe. In the same vein, therapies that have little basic science—and more importantly, therapies whose overriding explanations balk and contradict basic science, have strong vocal supporters with tradition and industry backing—these are the most likely to give false positives in clinical trials (because we shouldn’t be doing the clinical trials at all, we should be doing the basic science first!).

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