Alt Med – Risks of Untested and Unregulated Remedies

Alternative Medicine — The Risks of Untested and Unregulated Remedies – The New England Journal of Medicine – Marcia Angell, M.D. Jerome P. Kassirer, M.D

What is there about alternative medicine that sets it apart from ordinary medicine?

The term refers to a remarkably heterogeneous group of theories and practices — as disparate as homeopathy, therapeutic touch, imagery, and herbal medicine. What unites them?

It also constitutes a huge and rapidly growing industry, in which major pharmaceutical companies are now participating.  

What most sets alternative medicine apart, in our view, 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.

We still don’t have such studies that show alternative medicine to be more than slightly effective for some people for some conditions and certainly not as effective as appropriate medication.

In my view, “alternative” methods for serious medical conditions are for supplemental use while true medical treatment is also applied. For pain, many non-drug therapies can relieve some of it, but for most people, opioids are still by far the most effective for chronic pain that doesn’t respond to more conservative treatments.

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. They rely instead on anecdotes and theories.

Alternative medicine also distinguishes itself by an ideology that

• largely ignores biologic mechanisms,
• often disparages 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).

…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.

Now, with the increased interest in alternative medicine, we see a reversion to irrational approaches to medical practice, even while scientific medicine is making some of its most dramatic advances.

It is time for the scientific community to stop giving alternative medicine a free ride.

There cannot be two kinds of medicine — conventional and alternative.

There is only

• medicine that has been adequately tested and medicine that has not,
• medicine that works and medicine that may or may not work.

Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.

But assertions, speculation, and testimonials do not substitute for evidence.

Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments.

This article reads like it was written recently in 2018 but it was actually written 20 years ago! (September 17, 1998) Since then alternative medicine has only wedged itself more securely into our healthcare industry. (see Top US hospitals aggressively promoting alternative medicine)

I have tried many and used a few types of alternative medicine (homeopathy for poison ivy, attempts at meditation to calm anxiety), but I believe these “methods” are effective only for particular individuals in treated by particular practitioners.

I’m angry that these mostly ineffective methods that used to be derided by the medical establishment as “fairy tales” are now CDC recommended for our chronic pain. Such a bizarre turnaround in medicine shakes my faith in our healthcare system.

From Dr. Steven Novella in What Used to Be Fraud Is Now Alternative Medicine)

I think the most interesting phenomenon has been the re-branding of what 50 years ago was universally known as health fraud to an alternative to medicine.

This is now … what used to be fraud is now alternative.

And in order to make that sale, they, in a large way, turned science on its head.

They said, “No, we’re going to use science differently. We’re going to use different standards of evidence.

We’re going to use pragmatic studies as if they were efficacy trials, etc.

We’re going to ignore prior plausibility or scientific plausibility and it’s all good.

We’re going to have this ‘western medicine’ dichotomy that doesn’t really exist and pretend like some things can’t be studied, except in the ways we want them to be studied because those are the ones that give the results that we like.”

So, it’s been an amazing deliberate campaign to confuse how we know stuff in medicine in order to allow in this really low standard of evidence because these are treatments that don’t do well when you hold them to rigorous standards.

Here are a few other posts on “alternative/integrative” medicine:

• Integrative Medicine’s War on Pain and Science
• Mainstream Medicine Smitten by Hocus-Pocus
• JAMA: Journal of Alternative Medicine Atrocities