Mainstream Acceptance of Alternative Medicine?

Alternative approaches to medical treatment, commonly called complementary and alternative medicine (CAM), include such diverse treatments as herbal medicines, dietary supplements, and therapeutic touch. CAM is becoming increasingly popular: Surveys show that nearly half of U.S. adults had used CAM therapies in the previous year and document a trend toward more frequent use and higher expenditures (JAMA May 20; 279:1548; JAMA Nov 11; 280:1569). There has been a substantial increase in the number of clinical studies of CAM therapies, and recent issues of JAMA and sister journals were partly or entirely devoted to CAM.

During the past year, several studies reported the results of controlled trials of CAM therapies. Chiropractic manipulation was compared with physical therapy and an educational booklet for the treatment of low back pain and found to be slightly superior to the booklet at one month but similar in outcome at later follow-up (N Engl J Med Oct 8; 339:1021). In another study, garlic oil was found not to improve lipid profiles (JAMA Jun 17; 279:1900). On the other hand, ginkgo biloba extract appeared superior to placebo in a double-blind, controlled one-year trial of the treatment of dementia: Cognitive functioning was stable and social functioning mildly improved in the study group, while both deteriorated significantly in controls

The Rules of Science

Under the rules of science, people who make the claims bear the burden of proof. It is their responsibility to conduct suitable studies and report them in sufficient detail to permit evaluation and confirmation by others. Instead of subjecting their work to scientific standards, promoters of questionable "alternatives" would like to change the rules by which they are judged and regulated. "Alternative" promoters may give lip service to these standards. However, they regard personal experience, subjective judgment, and emotional satisfaction as preferable to objectivity and hard evidence. Instead of conducting scientific studies, they use anecdotes and testimonials to promote their practices and political maneuvering to keep regulatory agencies at bay. As noted in a recent New England Journal of Medicine editorial:

What most sets alternative medicine apart . . . is that it has not been scientifically tested and its advocates largely deny the need for such testing. By testing, we mean the marshaling of rigorous evidence of safety and efficacy, as required by the Food and Drug Administration (FDA) for the approval of drugs and by the best peer-reviewed medical journals for the publication of research reports. Of course, many treatments used in conventional medicine have not been rigorously tested, either, but the scientific community generally acknowledges that this is a failing that needs to be remedied. Many advocates of alternative medicine, in contrast, believe the scientific method is simply not applicable to their remedies. . . .

Alternative medicine also distinguishes itself by an ideology that largely ignores biologic mechanisms, often disparage modern science, and relies on what are purported to be ancient practices and natural remedies (which are seen as somehow being simultaneously more potent and less toxic than conventional medicine). Accordingly, herbs or mixtures of herbs are considered superior to the active compounds isolated in the laboratory. And healing methods such as homeopathy and therapeutic touch are fervently promoted despite not only the lack of good clinical evidence of effectiveness, but the presence of a rationale that violates fundamental scientific laws -- surely a circumstance that requires more, rather than less, evidence [5].

The AMA Archives of Dermatology recently published the parallel views of a German physician:

When deliberating on the essence of alternative medicine we should simultaneously reflect on the intellectual and moral basis of regular medicine. . . . (1) alternative and regular medicine are speaking different languages; (2) alternative medicine is not unconventional medicine; (3) the paradigm of regular medicine is rational thinking; (4) the paradigm of alternative medicine is irrational thinking; (5) the present popularity of alternative medicine can be explained by romanticism; (6) some concepts of alternative medicine are falsifiable and others are not; (7) alternative medicine and evidence-based medicine are mutually exclusive; (8) the placebo effect is an important factor in regular medicine and the exclusive therapeutic principle of alternative medicine; (9) regular and alternative medicine have different aims: coming of age vs faithfulness; (10) alternative medicine is not always safe; (11) alternative medicine is not economic; and (12) alternative medicine will always exist. The fact that alternative methods are presently an integral part of medicine as taught at German universities, as well as of the physician's fee schedule, represents a collective aberration of mind that hopefully will last for only a short time [6].

When someone feels better after having used a product or procedure, it is natural to credit whatever was done. This is unwise, however, because most ailments resolve by themselves and those that persist can have variable symptoms. Even serious conditions can have sufficient day-to-day variation to enable useless methods to gain large followings. In addition, taking action often produces temporary relief of symptoms due to a placebo effect. This effect is a beneficial change in a person's condition that occurs in response to a treatment but is not due to the pharmacologic or physical aspects of the treatment. Belief in the treatment is not essential, but the placebo effect may be enhanced by such factors as faith, sympathetic attention, sensational claims, testimonials, and the use of scientific-looking charts, devices, and terminology. Another drawback of individual success stories is that they don't indicate how many failures might occur for each success. People who are not aware of these facts tend to give undeserved credit to "alternative" methods.

The fact that an "alternative" method may exert a placebo effect that relieves symptoms is not sufficient reason to justify its use. Therapy should be based on the ability to alter abnormal physiology and not on the ability to elicit a less predictable placebo effect. Placebo therapy is inherently misleading and can make patients believe something is effective when it is not. Without controlled clinical trials, any treatment that is used could receive credit for the body's natural recuperative ability.

Medical "facts" are determined through a process in which hundreds of thousands of scientists share their observations and beliefs. Editors and editorial boards of scientific journals play an important role by screening out invalid findings and enabling significant ones to be published. Expert panels convened by government agencies, professional groups, voluntary health agencies, and other organizations also contribute to this effort. When controversies arise, further research can be devised to settle them. Gradually, a shared set of beliefs is developed that is considered scientifically accurate.