Keeping an Eye on Alternative Medicine
Hall, Harriet, Skeptic (Altadena, CA)
IN CASE YOU HADN'T NOTICED, SNAKE OIL IS ALIVE AND thriving under the shield of alternative medicine. As the Baby Boomers approach retirement age and develop health problems, we can expect an even greater boom of quackery, pseudoscience, and misinformation. Even the most critical thinking scientist may think less critically when he's sick. This column will examine questionable health claims using rigorous science and reason.
Altrnative Medicine is a Misnomer
There is really no such thing as alternative medicine. There can be alternatives in medicine (penicillin v. erythromycin) but there is no valid alternative to medicine. Either a treatment works, or it does not. As soon as science shows that a treatment works, it becomes a part of scientific medicine and is no longer considered "alternative." Treatments called "alternative" may be:
(1) Effective but not yet properly tested.
(2) Effective only as a placebo.
(3) Ineffective, but not yet proved ineffective.
(4) Proved ineffective.
(5) Obvious quackery that no one is going to waste time testing.
We can keep an open mind about (1), (2), and (3) without letting our brains fall out. We are justified in rejecting (4) and (5) unless new evidence overwhelms the old.
Complementary Medicine is Too Fuzzy
Complementary medicine includes anything added to standard medical treatment to make people feel better without having any objective effect on the course of a disease. Penn Jillette (the big, loud half of Penn and Teller) says that if all you want is to feel better, heroin will do quite nicely. Massages feel good; I'd feel better with a maid to do all my housework; my daughter would walk all over the mall on a broken foot if you gave her a $10,000 one-day shopping spree. Medical insurance should not be paying for maids and shopping sprees. Should it pay for massages? Where do you draw the line?
Where Do I Stand?
As a medical doctor, I do not recommend complementary and alternative medicine; but if a patient wants to try it, I am not "against" it. I'll say, "There's no scientific evidence that X works, but some people do think X has helped them, and if you want to try it, I'll work with you and continue to monitor your condition." I think patients have the right to try anything they want to try, as long as they are doing it with informed consent. What I object to is misinformation. If a chiropractor says he's going to try a manipulation that has seemed to help other patients with pain like yours, I have no problem with that. If he says you have a bone out of place and he's going to put it back, and you need regular maintenance treatments for the rest of your life to keep it there, I get real unhappy.
Case Study 1: Confusion About Glucosamine and Chondroitin
As a case study in the problem of alternative medicine, for many years now Glucosamine and Chondroitin (let's just call them G and C) have been recommended for osteoarthritis of the knee. There were some supporting studies, but they were not conclusive. Alternative medicine folks claimed G and C really worked, but since there was no money in it for Big Pharma, the necessary studies had not been done. Finally, the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health let the advocates of G and C design their dream study to prove once and for all that it worked. The original plan was to measure an objective endpoint: joint space narrowing; somehow they ended up measuring subjective symptom relief. The study was published in The New England Journal of Medicine (arguably the most prestigious medical journal in the world) and the conclusions were reported in my local newspaper--G and C worked no better than placebo.
In a rational world, this would have inclined most people to reject G and C, especially since the rationale for their effectiveness conflicts with some basic physiological principles. …