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:
Every time I read some foaming testimonial about how miraculous some horse-crap “alternative” thing, I’m reminded of Carl Sagan’s Baloney Detection Kit. Michael Shermer is another who wrote wonderfully about why people believe weird things (that’s the actual title of one of his books), ditto Martin Gardner. Since I live right next to one of the woo-woo capitals of the world (Eugene, Ore), I hear a LOT about “natural” remedies & how wonderful & harmless “natural” things are. I wanna tell ’em to go kiss a rattlesnake (they’re natural!) or eat some oleander or deadly nightshade…all natural! But when yet another person starts honking on about avoiding “chemicals” I just want to skull them. Or scream, “water is a freaking chemical, you moron! Everything is made of chemicals!!”
Of course, homeopathy & suchlike crapola works for people who really believe it works…but try explaining the placebo effect to them…
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I agree with you 95% :-)
However, I have found *some* “alternative” medicine useful at *some* times for *some* issues. With such qualifications, these methods can be useful, but not if they’re presented a “cure” for anything or even a therapy to be recommended for everyone.
For instance, homeopathic poison oak/ivy pills, in which case the intense dilution of the aggravating “chemical” (urushiol) in the pills allows the body to gradually build up some tolerance to it.
Or, the Alexander Method, which is a way to learn how to move using the proper body mechanics to avoid uneven stress on the spine – this and others like it have helped my headaches tremendously.
Or, limiting my sitting time by breaking it up with movements every 30-60 minutes. For my computer work, I use a little piece of software from http://WorkRave.org that allows me to set alarms (and blank the screen) for short and longer breaks as I see fit.
Or just exercise in general. Is that “alternative medicine”? It seems anything not provided by an M.D. qualifies and that’s pretty vague.
Okay, you got me. You’re totally correct; I hadn’t thought of the poison ivy desensitization thing, basically exactly what they did to me by giving me “allergy shots” thru-out my entire childhood (tho I managed to come up with whole new allergies as I aged). Much as it pains me to admit, that is an application of homeopathic-type medicine that is completely confirmed and effective, & I hadn’t thought of it that way. But I still reserve the right to roll about on the floor when reading things about how “activated water” (I think it’s called something like that) does any good –i.e. when they dilute the substance so much that there’s no actual molecules of it left, but the water somehow “remembers” & does something for health. ;-)
I haven’t heard of the Alexander method, but if it’s mechanics & anatomical physics, it sounds perfectly reasonable…mayhaps I need to rethink my own definition of “alternative.” I’ll have to look into that. And “pacing” (what my comprehensive pain program called it) has long been an important part of my dealing with the pain issues, tho it was hard to learn not to bull through & thus end up paying the price for overdoing it for days.
Exercise…that was always the only thing that ever had a significant effect on my migraines. Lots & lots of very vigorous, high-aerobic exercise definitely reduced both the frequency & severity. I never had anything remotely like the capacity for the amazing endurance events you did –every single time I worked up to running more than 4 miles at a time, I ended up with bronchitis & pneumonia til i finally learned to keep the distances short. I loved hard, fast-paced stuff like high-energy aerobics, highly competitive volleyball…*sigh.* Then the surgery nerve damage in 2001 & the more I exercised, the worse that pain got; the less I exercised, the worse the migraines got. I lose either way. I dunno if exercise is alternative, it just always seemed as important as eating or breathing. I grieve for it still.
I’ve lived in woo-woo central for so long, I realized I developed a visceral reaction to the word “alternative,” which is illogical & biased. Good to be reminded that it doesn’t always mean “wacko,” and I regret that I allowed myself to slide to that state of mind. Sloppy thinking isn’t good or useful. I like that reading your articles & comments informs, entertains, and sometimes helps me with a metaphorical boot in the brainstem :-)
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I’m very flattered – thank you! Our emotions can be overwhelming when threatened like this, and it’s hard not to get angry. So far, I haven’t been affected, I’ve used the same CVS pharmacy since the 80’s, and I have an excellent doctor who treats me like an equal, so I’m as “safe” as one can be these days.
It sounds like you traveled the same path I did and threw yourself into life enthusiastically until you no longer could. I’m glad I did all my crazy excessive physical activity while I still could, even though I’m sure I did some damage to my body… it was worth it!
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Me too…my knees & back have never forgiven me for the zillions of hours in the saddle, but tough noogies on them; I wouldn’t have traded one moment on horseback for anything. The other jumping & running around I’m sure didn’t help, but c’est la vie! …you are right; it was so worth it! I early on got used to having to be sorta binary when it came to exercise –full out until a migraine hit, then BAM, blind & bedbound. It was only after the surgery that I discovered how devastating it was not to have those uber-functional periods between the flat-out ones. Ick and then some.
I’m really glad you have such a good doc who treats you well; long may he/she practice!
And long may you write; you really are a bright light of sanity, sense, and science in a murky world of abysmal ignorance & PR-driven crap (not trying to suck up here, just saying “thanks” & offering a tip ‘o’ the hat).
May you have a great sleep & awaken to a low pain day!
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