Alternative (or complementary) medicine, as a concept, covers such a huge range of techniques and practices. However, broadly speaking, the term usually refers those techniques that fall outside conventional, pharmacological or surgical practices. In some countries such as the US and Germany practitioners are frequently physicians; in others they may have no medical training at all. Generally speaking both critics and supporters tend to define alternative medicine as any medical approach “that does not fall within the realm of conventional medicine”[i].
From the point of view this debate, the status of alternative medicine raises a number of problems, as is always the case with defining terms in the negative. It may be relatively easy to criticize the medical value of “crystal healing”, “psychic surgery” or a laying of hands, but aromatherapy, massage, chiropractic treatments and, notably, homeopathy are slightly harder to attack. However, there is a vibrant debate in all of these areas. In the same way that there are certain areas that Prop needs to leave off limits for the debate to work at all the same applies, for Op, to some ‘holistic’ treatments that realistically could be prescribed by a mainstream practitioner such as good diet and regular exercise or removing smoking and drinking – whether these are called pathogens or negative forces is, frankly, incidental. As a result this debate will focus on those areas that are contentious. Critically, it needs to focus on the extent to which some of the treatments currently on offer are simply an expensive scam. Another common criticism is that practitioners who promote their approach as, genuinely, an alternative, rather than a compliment to contemporary medicine can be taking risks with their patients’ health, hopes and even lives.
According to a survey in South Australia about half of the adult population of the developed world use alternative medicine,[ii] and in the developing world it could be considerably more. Either way it is clear that for a sizable portion of the world, complementary and alternative medicines represent a significant part of their medical treatment. It’s also worth noting that a large number of conventional remedies were once considered “alternative”. Indeed, the consumption of prepared herbs and plants said to have beneficial or medicinal properties, for example, predates written history and underpins sizable chunks of modern pharmacology. A significant auxiliary industry has now grown up around the process of identifying the active chemicals contained in flora and refining and concentrating their properties for use in clinical medicine.
Despite the sheer scale and duration of longitudinal studies conducted by the National Centre for Complementary and Alternative Medicine in the US (NCCAM) not a single study has provided firm proof for the effects that many popular alternative therapies are claimed to have. Arguably, of course, the moment science backs something up, it ceases to be alternative. Perhaps in the light of this Arnold Relman, former Editor in Chief of the New England Journal of Medicine commented, “There really is no such thing as alternative medicine – only medicine that has been proved to work and medicine that hasn’t”.
On a word of caution it’s easy for this debate to degenerate into either anecdotal evidence or a squabble about the psychosomatic benefits of one therapy or another. Generally both are best avoided, after all if Op proves the benefits of a placebo it’s not exactly something that is new to science which has been using them since its foundation and the fact that Aunt Bertha’s hip is much better now that she’s using reflexology is not really a point that lends itself to open debate.
There are good reasons why new therapies are tested in scientific trials first, rather than just released on the public that it might work. The first is to weed out side-effects but the other is that if you give most people a medicine they will, not unreasonably, expect it to make them better.
An entire industry has grown out of alternative medicines. No doubt many alternative practitioners are well meaning, but this does not change the fact that people are making money out of something that, as far as anyone can determine, is basically snake oil.
Although many people take both alternative and established treatments, there are a growing number of patients who reject conventional medical wisdom (there’s an account of one such case here[i]) in cases that prove fatal the availability of alternative medicines raises serious ethical and legal concerns, and also undermines the stringent regimes of monitoring and supervision that qualified medical professionals are subjected to..
The overwhelming majority of practitioners of alternative therapies recommend that they be used in conjunction with conventional medicine. However, the rights and opinions of the patient are foremost and should be respected. In the case of cancer, since that is the study considered by proposition, there are many sufferers who decide that chemotherapy, a painful and protracted treatment, which rarely yields promising or conclusive results, may well be worse than the disease.
Of course there is a cost associated with alternative medicine, although it is as nothing compared with the cost of many medical procedures, notably in the US but also elsewhere. There are plenty of conventional practitioners willing to prescribe medications that may not be necessary or, at the very least, select medications on the basis of financial inducements from pharmaceutical companies.
Despite legal rulings[i], such practices still take place; it would be disingenuous not to explore the extent to which commercial dealings influence the practice of conventional medicine.
Clearly advice should always be given on the basis of the needs of the patient. However, there are many circumstances in which conventional medicine fails to adhere to this principle. Venality and petty negligence are not behaviours that are exclusive to the world of alternative therapies.
The National Centre for Conventional and Alternative Medicines has spent over $2.5bn on research since 1992. The Dutch government funded research between 1996 and 2003. Alternative therapies have been tested in mainstream medical journals and elsewhere. Not only have thousands of research exercises failed to prove the medical benefit ”alternative” treatments for severe and terminal diseases, serious peer-reviewed studies have routinely disproved them.
It’s all well and good to pick at mistakes in individual studies. Indeed, this tactic often forms the mainstay of pleas for legitimacy made by members of the alternative medical community. However, the odds against such consistently negative results would be extraordinary.
By contrast, conventional medicine only prescribes medicines and treatments that are proven, and vigorously proven, to work.
Partly the problem here may well be that clinical research is simply looking for the wrong things. There is enough anecdotal evidence of success to at least suggest further research – it is worth noting that there’s no money in many of these treatments so they actually get relatively little academic discussion.
A meta-study of the available material on analyses of the effectiveness of complementary medicine by the Cochrane Library found positive or confirmatory outcomes in 34 percent of those papers it reviewed on the subject.
It is also worth reiterating that there is a massive financial interest in ignoring, sidelining or condemning therapies that pose a threat to the medical establishment.
It seems incredibly unlikely that people would come back for more than one dose of a treatment that was having no effect, and yet they do.
Thankfully only 4.4% of the 60million or so Americans who say they use alternative therapies rely on them exclusively. It is odd that in the cases of anecdotal accounts of the success of alternative medicines this statistic is rarely mentioned[i].
Equally, the impact of other treatment which may have been used by patients eager to credit complementary and alternative medicines with curing their conditions, tend not to get a look in, neither do the relative successes of conventional medicine.
This is probably why in every trial alternative medicine has a success rate of between 0% and 0%. By contrast there needs only be one instance of harm caused to demonstrate that this motion must stand. Interestingly, although conventional medicine publishes its mistakes in an effort to correct them, nothing similar exists for alternatives. Moreover, there are many accounts of fatalities caused by alternatives – both directly and indirectly through delaying accurate diagnosis as seen above (Oh, the same applies to animals too[ii]).
The food supplements industry alone is worth $250 a year worldwide, with little examination of the medical impact of merrily shoving things into your system that were bought at WalMart or Tesco.
Statistics for alternatives are difficult to generate as patients will often move between practitioners and frequently self-medicate.
Clearly there are also conditions that any responsible practitioner would refer to a specialist in that particular field.
However, many people are mistrustful of so-called conventional medicine and the alternative medicine sector has proven both popular and has often brought about changes in lifestyle as well as direct health benefits, if anecdotal evidence is to be believed.
Responsible practitioners have welcomed the actions of those governments who have licensed and regulated the Complementary and Alternative sector.
Although science may struggle to explain the benefits of these therapeutic technics, as they do not lend themselves to the tools of commercial medicine.
There is a fine line between what is considered alternative and what is thought of as mainstream. Techniques do move across that line and when they do so, they are seen as mainstream. However, this process of reform, refinement and acceptance takes time.
In the meantime it is simply unfair to deny treatment to patients who want it because the medical establishment is beholden to a conservative academic orthodoxy and drug and treatment providers with vested interests in ensuring that particular cures and techniques will continue to be purchased and utilised.
This comes down to the ‘well it can’t hurt, can it’ approach to alternatives. There is simply no serious medic – or any other scientist for that matter who would suggest that it’s a good idea to ingest products that are of dubious origin and purport medical benefits without having been tested. In many cases these have been shown to be at least irrelevant and at worst actively harmful.
Of course it is painful to deny treatment to a patient on the basis that the medication has yet to complete its trial stage but there is a reason for doing that in that it allows doctors to be 100 percent sure of a product before they’re prescribed.
It’s understandable that the medical establishment has an interest in ignoring treatments that are freely available. Pharmaceutical companies make billions each year selling drugs that cost pennies to manufacture.
There is an enormous vested interest in insuring that the world in general- and the West in particular-remain tied to the idea that the only solution to disease is to swallow a pill provided by a man in a white coat. There are other solutions that have been used for thousands of years before anybody worked out how to make a buck out of it. For much of the world these therapies continue to be the ones people rely on and the rush of pharmaceutical companies to issue patents on genes of some of these traditional remedies suggests that there must be at least some truth in them.
Absolutely nobody questions that many remedies can be drawn from nature- penicillin provides one example- but there is something of a jump that happens between chewing on a piece of bark and a regulated dose of a chemical.
Let’s deal quickly with the cost of medications – the second pill may well ‘cost pennies’; the first one, by contrast, costs hundreds of millions of dollars in research. On the basis that there is probably more than one medicine in the world that procedure will need to be repeated.
As for the idea that there are older or more traditional remedies and that these are still frequently used in much of the world, that is, indeed true. They are the same periods of history and parts of the planet were the bulk of humankind died – or continues to die – agonizing deaths from relatively commonplace diseases that modern medicine is able to cure with ‘a pill from a man in a white coat’. It is admittedly regrettable that more of the world isn’t covered by the protection science offers but that is scarcely the fault of science.
Modern medicine tends to treat an individual symptom without putting it in the context of the whole person and so will often fail to see it as part of a wider pathology.
Alternative practitioners tend to spend more time with their patients and so are better placed to asses individual symptoms as a part of the person as a whole rather than just dealing with symptoms one as a time as the crop up.
his is of course an excellent argument for more and better funded clinics, especially in parts of the world (including much of the West) where access to medicine is difficult.
It is also evidence that when people are genuinely worried about their health they tend to consult providers of conventional medicine who are, as a result, extremely busy.
It perhaps says more than anything else about many practitioners of alternative medicines that they have time to sit around bonding with their patients. Unsurprisingly, such a luxury is rare in an A and E ward or even in the average GP’s surgery.
Bratman, Steven, MD. “The Alternative Medicine Sourcebook”, Lowell House. 1997.