Last night, a friend who I have not seen for a little while, asked me an important question. She was well aware of my blogging activities as my blog rss feed pipes through delicious and then twitter and onto my facebook account, or something. Why my fascination with criticising alternative medicine? A difficult question – and after a few pints and the energy for a one word answer, I responded “sport”.
Fortunately, a journalism student asked me some interview questions that allowed me the indulgence of providing a little more depth to my reasoning. I repost them here for the record after bashing them out whilst also trying to cook a mushroom stroganoff. The strog was a success. I hope these answers are also digestible.
Is there any evidence that alternative medicines work?
That depends on which alternative medicine you mean and what condition you want it to work for. It also depends on what you mean by ‘work’. A complex question. What we do know is that most alternative medicines are essentially inert – they have no specific effects. Homeopathy uses medicines so dilute that no medicine remains. Reiki is just a form of faith healing. Acupuncture is just sticking pins in your body at arbitrary points. Reflexology is just a foot massage. Bach Remedies are just dilute brandy. Practitioners may claim specific effects due to ‘quantum theory’ or Chinese Meridians and Qi, but these are just pseudoscientific explanations with no basis of evidence or rationality. Some therapies may have specific effects such as chiropractic, but the evidence suggest that this is only effective for lower back pain and then pain killers may be just as good, and much cheaper. A few herbs have been shown to have specific effects, but patients have no way of telling if their herbs contain the right amount of active ingredient and are not contaminated with other compounds.
Do you think there is any merit in using alternative medicines and
therapies or is it more of a danger to health?
Even though specific effects may be non-existent, or at best unpredictable, alternative medicines may well give non-specific effects and these may indeed have positive effects. The use of alternative medicine may well give a sense of empowerment and control, lift the mood, reduce anxiety and make pain more bearable. Together, these effects tend to be clumped under ‘the Placebo Effect’. In itself, this is not harmful and it is clear to see why patients like to take alternative medicines. The dangers are wider though. Firstly, in order to gain a good placebo effect, you have to believe that the therapy will work. The therapist then has to be a liar or deluded about their own powers. Trust in medicine is pretty important and it can be argued that the mild benefits of placebo do not outweigh the loss of integrity in delivering a placebo. Also, placebo effects are not magic. They have effects concerning beliefs but do not generally alter the course of the illness. With serious illnesses, people taking alternative medicine may delay or avoid treatment with proven beneficial and necessary effects. Practitioners too fail to limit their claims to what can be expected from a placebo treatment as they often do not realise this is what they are doing. Therein lies the danger of alternative medicine.
Should more alternative medicine be integrated into the health system?
I see little problem with integrating alternative therapies that are not based on pseudo-science into mainstream practice when there are evidenced benefits to be gained. People with terminal illnesses, or those undergoing difficult treatments, may well benefit from such things as massage, music therapy and other anxiety reducers. However, I see little evidence amongst the champions of ‘Integrated Medicine’ that they worry about what works and what does not. The Princes Foundation for Integrated Health advocates all sorts of disproven and nonsensical therapies that may well do more harm than good. Such bodies never rule out any therapy – they have no standards by which they can judge their ‘integration’ effective. As such integrative medicine is just a back door attempt to gain public funding of quackery and it is a massive distraction from researching and funding genuine complementary therapies that people may well gain real benefits from.
Why choose conventional scientifically-tested medicines over alternative
therapies and medicines?
Patient choice is an important concept in health care thinking and rightly so. However, proponents of alternative medicine use the ideal of patient choice as a way of justifying quackery within the healthcare system. Choice is only really empowering when it is informed. That is, choice works when patients have available to them all the relevant information in a way that is not distorted by false or unproven claims and where the benefits and side effects can be compared on equal terms. For doctors, giving choice to the patient is vital, but they should not feel forced to provide treatments in the name of ‘patient choice’ when it is against their clinical judgement and the available evidence. People in all sorts of situations make difficult choices on the available evidence. We do not buy a second hand car on the word of the salesman. We seek independent and impartial evidence that the car is sound, not stolen and right for me. We would definitely feel we did not have a genuine choice of car if all we had was misinformation and raw salesmanship to hand. Why we are less diligent in our health choices is a fascinating question.
Is there anything you would like to add?
I believe the study of health beliefs and alternative medicine gives a fascinating insight into what it means to be human and how we form our opinions and views of the world. Human beings existed for most of their history with little more than familial care and plenty of ritual in the face of illness. For that reason, attempts to ban alternative medicine will be futile. It appears to fulfil some sort of deep need that mainstream medicine fails at. We are part of the first few generations that can begin to understand the true nature of disease and use technology to alter the course of illness. We may be becoming more technically adept at reducing suffering and early death, but we may be missing out on the human needs of such a process. But also, modern medicine can be pretty brutal in the face of deadly disease. Risks are taken to save lives and much discomfort is endured on the path to recovery. The tension that exists is between allowing alternative medicine to provide the ritual of healing that may be missing without allowing it to appear to provide alluring and easy answers to suffering that do not really exist. What is so disappointing is that the practitioners of alternative medicine do not want to take part in that debate but instead want to cling to their nonsensical beliefs and unevidenced practices. And it is on that point that real conflict exists between mainstream and alternative medicine.