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Alternative Medicine – Reply to Comments

by Steven Novella, Dec 29 2008

My previous post on the skeptical battleground of so-called alternative medicine resulted in a great deal of discussion. There are too many comments for me to reply to individually, so I will answer all the main points raised here. Many of the usual points on the pro-CAM side were raised, and even though I have gone over all of them before on NeuroLogica and Science-Based medicine, it is worth reviewing them here.

Doctors are bad

Many of the comments made the basic point that the popularity of CAM is the fault of evil, uncaring, incompetent or dangerous doctors. These comments took one of two forms – using negative claims about doctors and medicine to explain why CAM is popular, and using them to justify CAM. These are similar but distinct claims. The latter claim, that CAM is legitimate because scientific medicine “doesn’t have all the answers” or is uncaring or corrupt, is a non sequitur. The position of CAM critics like myself is that CAM treatments are unscientific, not proven, and often already proven to be unsafe or ineffective. There should be a single science-based standard of care for all medicine – not a double standard where fraud and unscientific claims can flourish. If we are currently not doing an adequate job enforcing the standard of care that is not a justification for abandoning it – it just means we need to figure out how to do a better job.

The claim that people are attracted to CAM because of the failings of scientific medicine seems to be the default assumption on the part of CAM apologists, but there is little evidence to support this claim. In fact what few surveys that have been done show that dissatisfaction with scientific medicine is a minor factor in using CAM. Users site the desire to feel as if they have control over their health care and philosophical reasons for their choice of CAM. Also, 85% of CAM users continue to use scientific medicine and use CAM only to “complement” their health care. They are not choosing CAM instead of mainstream medicine – they just want to explore all their options.

So motivations for CAM use are more complex than the simple-minded propaganda of  “doctors are bad.” But there is a kernel of truth to this claim. It is true that the experience of mainstream medicine can often be cold and complex. The current ethical standards of informed consent mean that doctors are obligated to tell patients the unpleasant truth. Tests are often unpleasant to endure also.

Further, managed care has put tremendous pressure on the health care system and as a result office visits are generaly shorter than they have been in the past. The bottom line is this – the system is paying for less medicine (especially for E&M – evaluation and management), so patients are getting less medicine. Many older physicians in the 1990′s simply retired, because they literally could not afford to keep their practice open. For medical practice not based on procedures revenue is down by about 60% over the last 20 years.

Of course, if patients are willing to pay out-of-pocket then they can get as much time as they want with their physicians. This is the model of so-called boutique clinics, or some spciality clinics. It is also the model of most CAM providers, not by coincidence.

My point is that the answer to the challenges of the overwhelming costs and subsequent compromises of modern medicine is not to abandon the scientific standard of care. Again – that is a dangerous non sequitur. In fact, CAM just worsens the problem by diverting funds away from standard medicine.

Also, I acknowledge that CAM practitioners have largely mastered the psychological aspects of a positive therapeutic relationship. Those are the selective pressures they have been under – to tell their clients what they want to hear. They are not constrained by science, by informed consent – in short, by the truth. They are free to give a simple explanation for every client that walks through their door, to claim that they have the answer for everything, and to design their treatments to be pleasant rather than effective. Being disconnected from science and ethics can be very liberating.

There were also some specific claims made that I want to address. Tracy wrote:

The problem with EBM is it takes too long and doesn’t take the human cost of its long delays, or the format of its trials, into account.

The current regulatory setup is incredibly slow and somewhat unethical. Its unethical to give dying people placebos in trials, yet its what has to be done right now.

This is both misleading and a logical fallacy. It is another form of the argument from final consequences – people need treatments, therefore they should get them. But what if no such treatment exists? Does that mean it is ethical to make up a fake treatment?

The statements are also false. The delay of doing clinical trials is definitely taken into account. It is even possible to get experimental treatments on a compassionate basis for terminal illnesses. Researchers and ethicists have actually spent decades being quite thoughtful on all these issues. Also – it is unethical to withold a proven treatment from someone to put them in a trial – so no one gets a placebo instead of a proven treatment. Preliminary open (no placebo) trials are often done before placebo-controlled trials, and if a treatment were dramatically effective it would be fast-tracked. When possible the placebo arm is limited to 1/3 of study patients so that the chance of getting a placebo is minimzed. Also, trials are monitored so that if a treatment is proven adequately to work before the trial is scheduled to conclude it can e stopped early so that that the treatment can be made available right away. In other words – every effort is made to get effective treatments to dying or suffering patients as quickly as possible.

But Tracy’s type of comments are common – people who don’t have any actual experience in medicine or clinical research base their conclusions on assumptions and second-hand information, or perhaps what they see on tv. But they have no relationship to the actual ethical standard in medicine.

Paula made a similar point when she wrote:

When people do not have satisfactory solutions to their ailments from traditional medicine, what would you skeptics propose they do? Just sit around and die?

Of course not. Take any reasonable action. The more desperate one’s situation, the greater the justification for speculative and risky treatments. But this is already incorporated into the ethics and practice of scientific medicine. There is a line, however – do not abandon all science and reason.

There is also a hidden assumption in Paula’s point – that short of a cure there is nothing to do but go home and die. This is almost never the case. When a terminal disease cannot be cured there is often a great deal we can still do to maximize the duration and quality of life. It is far better to focus your efforts on that – get the most out of the time you have left -then to spend your remaining days spending your family’s money searching for a cure that does not exist. I have seen patients spend tens of thousands of dollars on unsafe and unpleasant treatments outside the country, grasping for a sliver of hope that turned out to be a false hope. They typically greatly regret the experience. It is like hitting a drowning man over the head with a sledgehammer.

Some blamed the popularity of CAM on the for-profit nature of “corporate” medicine. This is certainly part of the anti-medicine propaganda. Also, as is commonly the case, there is a kernel of truth. Conflicts of interest are a problem – but they are recognized and are largely being delt with. Contrary to one commenters claims – doctors do not get “kickbacks” from pharmaceutical companies. Kickbacks are illegal. Large gifts from pharmaceutical reps for listening to their sales pitches have mostly already been weeded out. Small gifts are on the wane also – mainly due to internal criticism by doctors who feel it taints our reputation with the appearance of conflict. They probably have a point. But, to be clear, medical decision making is largely driven by the standard of care – not financial conflicts of interest. Actually, the biggest conflict probably comes from managed care, which provided a huge incentive not to treat.

This is a tangential issue – but it is impossible to design an incentive-neutral system. Whoever pays for health care will be motivated to minimize it, and whoever profits will be motivated to maximize it. You can shift the incentives around, but you cannot eliminate them.

And, let’s remember that the whole argument is the fallacy of inconsistency. CAM is largely a for-profit cottage industry. They are just good at attacking their competition.

Doctors kill patients

Several commenters brought up the fact that many patients die from either medical mistakes or adverse drug reactions. David Paterson specifically concludes that patients would have a better outcome going to a witch doctor than a medical doctor.

This argument, however, is based entirely on a fallacy – considering only the risks and not the benefits. Dr. Harriet Hall wrote an excellent recent post on one of the studies David cited, making that same basic point. First, the numbers cited are likely greatly exagerated, but that is a side point I don’t have time to go into today. Even if we take them at face value – the point is that medical decision-making is all about risk vs benefit. In order for any treatment to be considered ethical and part of the standard of care it must demonstrate benefit in excess of risk. Standard of care also includes giving informed consent regarding the calculation of risk vs benefit.

Clinical trials are designed to look at the net effects of a treatment – if the only variable is the use of a specific treatment vs a placebo, what are the final outcomes for the patients?

In fact, my primary criticism of CAM is that they generally have not gone through this analysis. Most CAM modalities (I know I am lumping here, but remember I am against the CAM category – every treatment needs to be considered individually, but I am responding to the CAM proponents) have no proven benefit or have not demonstrated benefit in excess of risk.

It is therefore absurd to criticize scientific medicine in favor of CAM over the issue of risk.

The issue of risk management is medicine is a legitimate and serious issue. But there already exists mechanisms within mainstream medicine to address the problem of mistakes and failures to meet the standard of care. A great deal of progress has already been made, but we do need to do much better still. The answer largely is in putting into place redundant systems that minimize error. This is increasingly necessary as the practice of medicine becomes more complex.

Of course, if all you are doing is waving your hands over a patient there is not much that can go wrong – but there isn’t much that can go right, either.

CAM is preventive

Some of the commenters made the point that CAM focuses more on prevention. This is simply not true. All of the real effective preventive health measures, like diet and exercise, were discovered (and continue to progress) through scientific medicine. Primary care doctors routinely advise patients to quit smoking, lose weight, eat a healthier diet, etc. Blood pressure is often managed by reducing salt, high cholesterol by dietary changes, and diabetes by going on a diabetic diet and exercising regularly. Aspirin is routinely prescribed to prevent heart attacks and strokes. In my own practice I advice withdrawal of dietary triggers (like caffeine) or hydration to manage migraines, change in “sleep hygiene” to manage sleep problems, and stretching, exercise, gentle massage and moist heat to manage back pain. I routinely check certain vitamin levels and prescribe supplements as needed. The list goes on.

It is simply absurd to argue that doctors do not emphasize life-style changes or prevention. These have already been built into the standard of care. Such interventions are also often the low-hanging fruit – that’s where we start because it is easy and low risk. Medical management is used when the lifestyle changes are not enough, and invasive options, like surgery, are a last resort.

More importantly – we question what we do, we conduct research to find out what the best options are, and we change what we do based upon that evidence. CAM practitioners do not change what they do in response to scientific evidence. They certainly have never abandoned a worthless modality.

Can we do better? Of course. That will always be true. But we are doing better. Simply taking a snap shot of the current state of medicine and arguing that any deficiencies warrant abandoning science as the standard of medicine is absurd.

Conclusion

I know I did not get to every point. I could have written a dozen articles this length addressing every side point raised in the comments. But I hit the highlights – the points that are most commonly raised. I don’t expect this entry will end any debate. This is too complex and emotional an issue.

I do want to emphasize my central theme. Most of the comments were distractions from the central issue – the public is best served by medical practices that are safe and effective. The best way to maximize safety and effectiveness of medicine is through a standard of care based upon the best science available. Magic and false hope are no substitute.

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63 Responses to “Alternative Medicine – Reply to Comments”

  1. Margaret F. says:

    I’m not familiar with the acronym CAM. The first time you use an acronym please spell it out.

  2. Watson says:

    Dr. Novella,

    As you know, it is very easy to make unsupported claims. It is very time consuming to refute those claims. Thank you for your persistence and dedication.

    Alternative medicine seems to have permeated our culture further than other psuedo-sciences, and therefore will require even greater effort to overcome. Do you happen to know if the new administration has any plans to clamp down on fringe medical practice?

  3. Watson says:

    Complementary and alternative medicine (CAM)

  4. Patrick says:

    This is going to sound odd at first, but hear me out:

    I wish that Dr. Novella, or someone else with such patience and careful reasoning, would be invited to the Oprah show. No one has such a platform for informing the public as Oprah does. Unfortunately, she chooses to put on woo-pusher after woo-pusher, misinforming her audience. Wouldn’t it be great if science-based medicine could make it on to her show, with what Steve just covered as the subject matter? :)

  5. Bill says:

    Patrick:
    Yeah, it’d be great to see some anti-woo on a forum like Oprah. Sadly, though, that ain’t where the ratings are.

    It’s a vicious feedback loop – Oprah gives her viewers what they want. The viewers reward her for it. Rinse, lather, repeat.

  6. ejdalise says:

    Just curious, and a side note; at some point or other we are likely to have a nationalized health insurance plan. My limited exposure to the people who are advocating such seem to point to the unwanted (on our part) consequence of more CAM falling within the implied umbrella of legitimacy as some of the procedures will be included in the coverage not because of merit, but because of popular demand.

    I know many insurance companies are oft maligned (and sometimes justly so) for their resistance to cover non-standard procedures, but at least they seem to have some understanding of the science requirements when it comes to treatments.

    Do we fear that a national health plan will be governed more by politicians catering to vocal segments of the public? I hope I am wrong, but it sure seems to me that will be the case.

  7. Dr. Nancy Malik says:

    Homeopathy cures even when Conventional Allopathic Medicine (CAM) fails

  8. mat alford says:

    Homeopathy sure is a great cure for thirst. Apart from that, references would be nice, Nancy…

  9. Dr. P says:

    actually I have found homepathic preparations are great for sweetening coffee or tea with the benefit of portion control, the little “pills” are much easier to add a standard amount of sugar than a spoon

  10. Mike says:

    “It has been said that scientific medicine is the worst form of health care except all the others that have been tried”
    (With apologies to Winston Churchill)

    Once again, I think you are spot on Steven, the current system is the best we have despite its many problems and if does offer the vital ability to learn from its mistakes and advance knowledge.

    Can any branch of CAM say that?

  11. Mike says:

    Have you ever wondered how difficult it must be for a homeopathist to clean out his medicine containers because every time he washes it with water he will dilute it and make it even more potent!!!

  12. Looks like I’m out of luck; I sweeten neither coffee nor tea. Does this mean I must water down my non-dairy creamer?

    Seriously – you must get a huge number of comments from the fringe. Any analysis of the ratio kook:rational?

    Love the work, by the way. You are helping this somewhat naturally gullible boy keep his brain in tune.

  13. Rogue Medic says:

    Why tread gently around these deadly treatments?

    Homeopathy kills.

    CAM kills.

    Science-based medicine is continually working at improving outcomes. Not all changes will be improvements, but over time, the result will be significant improvement in the available treatments.

    A century ago, the life expectancy was a little more than half of what it is now. The improvement is mostly due to science-based medicine. Sanitation does have a lot to do with that, but CAM had nothing to do with the epidemiologic studies of hygiene.

    To repeat.

    Homeopathy kills.

    CAM kills.

  14. Tressa says:

    Thanks as always. Great work. This is another one I’m printing out for my grandmother to read.

  15. JakeR says:

    ejdalise — December 29, 2008 @ 1:00 pm : I know many insurance companies are oft maligned (and sometimes justly so) for their resistance to cover non-standard procedures, but at least they seem to have some understanding of the science requirements when it comes to treatments.

    I’d like to see some data on this assertion. Admittedly, most if not all insurance companies won’t pay for chelation therapy for autism. Many insurance companies, however, now cover acupuncture and therapeutic touch, for example.

  16. Drew says:

    Regarding prevention:

    My most recent trip to the doctor was for a routine checkup. The whole time I felt like the doctor was annoyed that I had come in when there was nothing wrong. He didn’t ask any questions or make any comments regarding my daily life, and what small things I had wanted to ask about I found myself avoiding asking because I felt like the doctor didn’t want to hear about it.

    The same day my partner visited a doctor who had trained under Dr. Andrew Weil. She asked all about her diet and exercise and gave lots of advice on generally keeping in good health all while being friendly and responsive. She didn’t recommend any quack therapies or anything.

    I know it would generalizing from a single example for me to suggest that this really says anything about the medical philosophy of Dr. Weil versus mainstream medical practice, but I can’t deny that it had an emotional impact.

  17. Alasdair Dubh says:

    I had my gallbladder removed two weeks ago. Some years ago, I’d still be at the beginning of a long and uncomfortable recovery. Thanks to the continual progress of “mainstream medical practice” the surgery nowadays is relatively simple and the recovery period has already gone by.

    I first went to my doctor at the end of July because I was waking up every day feeling as though I’d just eaten a hearty Thanksgiving dinner. I had a lot of stomach upset. It was not an easy diagnosis. I had a stress test, then endoscopy, then ultrasound, then CT scan. My own eagerness to participate in the process, and my own natural curiosity, probably complicated things. Due to the discomfort caused by eating, I began to lose weight. My limited knowledge of my own anatomy led me to misinform my doctors. My attempt to participate in the process with self-education was not always received with enthusiasm. Finally it became clear that my gallbladder was the problem. It was not an ideal process, and involved three doctors. The surgeon was upfront about risks, but I felt he minimized the recovery time. I was the first of seven patients he would operate on that day.

    Not a perfect system. My doctors are just ordinary people. Some are more likeable than others. I’m not a terribly good patient. The gastrointestinal tract is a complicated bit of biology. I found some things annoying, and I bet my doctors sometimes found me annoying. But now I can eat normally again. Fatty foods don’t hurt or make me nauseous (actually I wonder if this is a good thing or not!)

    And… I know from the tests that if my stomach acid isn’t controlled, I’ll have a higher risk of esophagal cancer. I have slightly enlarged aorta (fortunately I will probably never have high blood pressure). The doctor who looked at my CT scan noted micronodules in the part of my lungs that he could see (yes, I quit smoking a few years ago). So now I know some things to keep an eye on as I grow older. And I know that in general, I’m in very good health.

    It’s not perfect. People are people, and nothing we do matches the magical perfection that our imaginations can idealize – but that same imagination fuels our reason and discovery. But as I enjoy my winter holiday feasting, I’m happy to know I’ve got the benefits of medical science watching my back.

  18. James says:

    I hear those kind of bad arguments in favor of CAM all the time (my Mother veers into the alternative medicine quagmire from time to time) and I’m glad to hear you address them.

    I think, though, that the main detractor away from real medicine into CAM-land is that almost all of these alternative measures offer miracles. Sure, homeopathy may seem like the craziest thing in the world to people like us, but put yourself in the place of a sick individual, desperate for a cure. Homeopathy, or magnets, or voodoo rituals are going to start sounding pretty good to someone fed up with the normal system. So to get around the gullibility factor, we either need to brighten the image of real medicine, or do more to debunk the frauds.

  19. Barry says:

    As Dr. Steve pointed out, most people who choose CAM apparently do it to complement their mainstream medical treatment. Where CAM becomes particularly risky is when it is used as an alternative. A catalogue of the dangers related to doing this is the medical section of the website What’s the Harm?

  20. Cambias says:

    I’m with “Rogue Medic” above — quit using those stupid namby-pamby acronyms like “CAM.” To the untutored, it sounds like some sort of genuine medical term, along with MRI and HIV.

    Let’s call this evil what it really is: quack medicine, fraud, fakery, or nonsense.

  21. BillDarryl says:

    Anyone see this article on msnbc?

    http://www.msnbc.msn.com/id/28391830/

    In short, American conumers are using less echinacia and superdosing on vitamin C to combat the common cold. They credit effective communication from scientists regarding their validity (rather, lack thereof) as the reason for the decline.

    That’s really encouraging. Apparently people can grasp when science trumps an alt-med cure claim. So keep spreading the word, peoples!

  22. BillDarryl says:

    …my Mother veers into the alternative medicine quagmire from time to time

    Can we refer to the “alternative medicine quagmire” as the “quackmire?”

  23. Joe says:

    I like Mark Crislip’s acronym better:
    Supplements, Complementary and Alternative Medicine (SCAM)
    http://www.quackcast.com/

    I think SCAM only appears to be larger than it really is… mainly because the “file drawer effect” applied to TV. Negativity doesn’t sell… even my mom said “that’s the problem with knowing too much science”, referring to discovering that very well known beliefs (such as vitamin C preventing colds) turn out to be false.

  24. Muzz says:

    I think one reason many seek out alternative medicine is that Western medicine tends to operate according to a sick model – that is, just treating illness, rather than promoting wellness. Alternative medicine practitioners listen to patients and promote paying attention to one’s body. They give the sort of empathic attention that patients want, and that doctors are often too busy to give.

    Too bad that the CAM practioner’s excellent bedside manner and attention to wellness comes with a medical approach that is pure hogwash.

    I fear uniting the two would be too expensive.

  25. John says:

    I like the flip side analysis. Going to the doctor is a major PITA. Almost all of us, at least in the US, can’t afford to see a provider that isn’t understaffed. Long lead times to get an appointment, often a long wait when you get there, often followed by an assistant taking observations, then a rushed token visit by your doctor, just enough to make sure the recommendations or prescriptions are legal. Not always, but often enough.

    The service is lousy! Would you go to a restaurant that treated you like this? Well, we don’t need to go to restaurants, which is why we don’t see this. However, medical service has become so aggravating, that doing without can seem like a viable alternative. I know too many people who haven’t had a simple physical for quite a few years, risking their health to avoid the hassle.

    Not that all of CAM’s victims are constituted of these people, but CAM does certainly take advantage of these circumstances to a large extent. Addressing these issues would not only deprive CAM of desperate victims, but improve the accessibility of real medicine and the quality of life for others as well.

  26. Fred says:

    There is no such thing as alternative medicine. Crap-based medicine is a much better and more accurate description. That is something Dr Novella really emphasizes – the CAM term is a victory for the proponents of these unscientific modalities.

  27. Max says:

    “What’s the harm?” If you’re dying from a treatable disease, the harm is in forgoing a proven medical treatment. If you’re suffering from a merely annoying condition, the harm is in seeking medical treatment that can kill you.

  28. BillDarryl says:

    Muzz #24… I sort of agree.

    Western medicine (and I include the American government’s health institutions) does indeed promote wellness, mainly through three recurring points:

    - Discipline your eating
    - Exercise regularly
    - Get regular checkups

    I just think that for most people, this is simply not sexy enough. Honestly, which sounds cooler to you – balancing your energies through mind/body awareness and meditation, or putting down the cheeseburger? Buying and sporting a pretty magnetic bracelet, or working up a sweat with a brisk 20 minute walk?

    So I don’t think alternative medicine is doing something Western medicine isn’t by focusing on “wellness.” But I do think they’ve capitalized on a consumer population’s demand for shiny new things vs. same old same old (even if the shiny new thing is junk and the same old same old works just fine).

  29. Lee Cooper says:

    “…Addressing these issues would not only deprive CAM of desperate victims, but improve the accessibility of real medicine and the quality of life for others as well.”

    I don’t know about that. Seems like those who put a great deal of stock in CAM are those who tend to distrust the medical “establishment” as a rule and not a reaction to customer service issues. The way I understand it, one of Steve’s points is that the CAM industry must consentrate on service as a sales tool expressly because their treatments do not foster results. The CAM salesman must reach the customer on an emotional level as any actual physical results will be nil and said customer must be persuaded to feel better.

  30. Dave says:

    You (correctly) dismiss CAM, but then state to “routinely check certain vitamin levels and prescribe supplements as needed”.

    You obviously don’t include Vitamins and Dietry Supplements in your interpretation of CAM’s. Should the physician be taking some of his own (skeptical) medicine?

    Am I missing something here? Joe (23) is on the mark.

  31. The human disdain for having consoling beliefs debunked, and our resistance to accepting the debunking, begins when we realize Santa isn’t real. It gets worse from there.

  32. Max says:

    Dave, you know there is such a thing as vitamin deficiency. Treating a specific deficiency is not CAM. CAM is prescribing vitamins when they’re no better than a placebo.

    But as I mentioned in another thread, many doctors do prescribe vitamins as a placebo when they’re out of ideas. They may also assume that you’re deficient because the “average person” is. That’s called the ecological fallacy, and it’s easier than actually testing for the necessity of treatment and for signs of improvement.

  33. Max is correct in that there are vitamin deficiencies that need to be treated. Treating a deficiency is not the same thing as megadosing or routine supplementation. And yes – vitamins and nutrition have always been part of scientific medicine. They were simply coopted by the SCAMers.

    I do not supplement empirically, however. I test levels and supplement when they are low. There are specific neurological disorders that can be caused or exacerbated by specific vitamin deficiencies. B12 deficiency is common in older patients due to a decrease in our ability to absorb B12 as we age. This contributes to neuropathy or memory difficulty. If levels are low I supplement. From a risk/benefit point of view it’s a no-brainer.

  34. Max says:

    There’s also the whole public health program of food fortification. Iodized salt, vitamin D milk, enriched wheat, even fluoridated water.

  35. David Paterson says:

    Dear Mr. Novella,

    It seems to me that you are living somewhat in denial about the fact that western medicine men are in fact the third leading cause of death in North America.

    You state that the “numbers cited are likely greatly exagerated”, when they come from the Johns Hopkins School of Hygiene and Public Health, The National Academies, and a large study published in
    the Journal of the American Medical Association.

    However, if anything, the numbers are understated. The last study, for example, “excluded errors in drug administration, noncompliance, overdose, drug abuse, therapeutic failures”.

    The National Academies article stated:

    “Studies indicate that 400,000 preventable drug-related injuries occur each year in hospitals. Another 800,000 occur in long-term care settings, and roughly 530,000 occur just among Medicare recipients in outpatient clinics. The committee noted that these are likely underestimates.”

    .

    You also state that my “argument is based entirely on a fallacy – considering only the risks and not the benefits”.

    When is is so dangerous to go to a doctor that your risk of dying because of medical errors is just after cancer and heart disease, and if the numbers are in fact understated, may be on a par with cancer and heart disease, then clearly, going to a doctor, and in particular checking into a hospital, is a potentially life threatening decision.

    The Johns Hopkins report concluded that hospitalization lead to 12,000 deaths from unnecessary surgery, 7,000 from medication errors, 20,000 from other errors and 80,000 from infections. All this on a yearly basis.

    There are benefits that in many cases outweigh the risks. If you are in a car accident, western medicine can do amazing things.

    Any contact with western medicine for non life threatening situations is obviously another matter.

    With close to a quarter million unecessary deaths every year, where is the benefit?

  36. BillDarryl says:

    The Johns Hopkins report concluded that hospitalization lead to 12,000 deaths from unnecessary surgery, 7,000 from medication errors, 20,000 from other errors and 80,000 from infections…. With close to a quarter million unecessary deaths every year, where is the benefit?

    12,000 + 7,000 + 20,000 + 80,000 = 119,000. Where are you getting “close to a quarter million” from?

    (Related: Where on earth is Dr. Novella getting the idea that some figures are being exaggerated?)

  37. shahar.lubin says:

    While I whole heartedly agree with Dr. Novella, I wonder where the libertanian contigency of the skeptic movement(like Dr. Shermer) stand on the issue. Aren’t they’re against – or at least for minimal – government regulation and believe popular choice and market forces will work out best in the end?

  38. Richard Kong says:

    You also state that my “argument is based entirely on a fallacy – considering only the risks and not the benefits”.

    The Johns Hopkins report concluded that hospitalization lead to 12,000 deaths from unnecessary surgery, 7,000 from medication errors, 20,000 from other errors and 80,000 from infections…. With close to a quarter million unecessary deaths every year, where is the benefit?

    And you conveniently ignore the fact that modern medicine has helped millions. Is that not the fallacy Mr. Steven pointed out that you were so eager to put under scrutiny, yet once again?

  39. Max says:

    David,

    Look, let’s consider Lasik. No CAM will restore your eyesight to 20/20, so surgery is your only option, but there’s a small chance it’ll screw up your eyes. Is the risk worth it? That’s up to you. Suppose your poor vision prevents you from pursuing your life’s dream of being an Air Force pilot. Now is the risk worth it?

  40. Max says:

    Shahar,

    As Dr. Novella noted, CAM appeals to both the anti-corporate leftists and the anti-regulation libertarians. In the other thread, I linked to a Randist who wants to abolish or at least cripple the FDA. An alternative could be something like the Underwriters Laboratories, a private non-profit product safety testing and certification organization. But UL itself is approved by the federal agency OSHA.

    From Wikipedia:
    “The UL Mark does not carry any legal weight beyond that of any other trademark… In practice, however, it may be extremely difficult to sell certain types of products without a UL Mark. Large distributors may be unwilling to carry a product without UL certification, and the use of noncertified equipment may invalidate insurance coverage.”

    I’m not sure if libertarians think that false advertising is protected by freedom of speech. It’s more a question of values than of skepticism.
    “I disapprove of what you say, but I will defend to the death your right to say it.”

  41. Max says:

    Libertarians are also likely to be against public health measures like mass vaccination and water fluoridation. That doesn’t mean they reject the science behind it, but chances are they do if they’re extreme enough.

  42. David Paterson says:

    BillDarryl stated:

    “12,000 + 7,000 + 20,000 + 80,000 = 119,000. Where are you getting “close to a quarter million” from?”

    Read the original article from the Johns Hopkins School of Hygiene and Public Health:

    http://www.ratemds.com/social/?q=node/12415
    http://jama.ama-assn.org/cgi/content/extract/284/4/483

    This was posted in comments followqing the original article by Mr. Novella about alternatve heath:
    http://skepticblog.org/2008/12/15/skeptical-battlegrounds-part-iii-alternative-medicine/

    The figures you quote are only hospital deaths. There are over 100,000 deaths from “non-error, negative effects of drugs”. This puts the total at about 225,000 per year.

    These drug deaths have also been documented in another study:

    http://jama.ama-assn.org/cgi/content/abstract/279/15/1200

  43. Alan Hoch says:

    CAM is all junk, but I do think a lot of its appeal comes from a modern medicine establishment that is often cold, uncaring, and disinterested in doing a good job. Yes, they are still clearly the best shop in town, but for someone already interested in CAM an unpleasant treatment with regular medicine can serve as an easy self-justification for trying out “alternative” treatments.

    Likewise, even someone not prone to trying out CAM might be convinced to do so by a friend or whomever after a (all too common in my experience) bad experience with the medical establishment.

    Thus, a way to help stop the spread of CAM is to improve the bedside manner and general “I give a damn” attitudes in regular medicine. No one likes JUST being seen as a number or a necessary evil to get paid.

  44. Abelardo Duarte says:

    Dr. Novella is missing the main point…. Alternative medicine is crap, BS and a bunch of lies. Now if people, knowing this, go and give money to the shaman, that’s just not my problem anymore and in the end, everyone needs to make a living, including shamans.

  45. One point I brought up in a conversation recently was that people tend not to recognize the difference between medical science and medical culture. There are lots of things to be embarrassed about in our medical culture: the conflicts of interest you brought up, the structure of the healthcare system, routine infant circumcision with no medical justification, etc.

    By emphasizing this distinction, I think it will be much easier to nudge believers in the right direction. It gives us a way to find common ground which should help them to be more receptive to our views.

  46. Max says:

    When you say, “CAM is all junk” or “Alternative medicine is crap”, what are you referring to? All folk medicine? Cheap home remedies? Off-label drug prescriptions? Anything that hasn’t passed a double-blind clinical trial… like parachutes?

  47. The Blind Watchmaker says:

    There’s what has been shown to work. That is “medicine”.

    Ideally, we are talking about practices that have passed a placebo controlled, randomized, double blinded trial. But it also means practices that are based on plausible science. If, one day, a generally accepted practice is actually put to the ideal test and fails, then it is no longer medicine.

    The “alternative” to this is what has not been shown to work, or worse, what has been shown to not work. That is CAM. (or as Mark Crislip is fond of saying, “Suppliments, Complimentary and Alternative Medicine” or “SCAM). Presenting unplausible treatments or disproven treatments as real medicine is a SCAM.

    Most SCAM is relatively harmless. However,when one has a serious condition and chooses SCAM over science based medicine, then the harm begins.

    Check out http://whatstheharm.net/

  48. “When you say, “CAM is all junk” or “Alternative medicine is crap”, what are you referring to?”

    I can only speak for myself so here’s what I’d say:

    “All folk medicine?”

    Pretty much, yeah, unless it has also proven itself scientifically (like certain herbs from which we derived many of our synthetics).

    “PCheap home remedies?”

    It depends on whether they’re based on myth or fact. It’s a fact alcohol helps disinfect wounds, so pouring a bottle of vodka over a gaping hole in your leg is probably not a bad idea. Chicken soup for colds? Sure… It’s got a few symptom-suppressing powers.

    But when it gets into the realm of things like picking certain plants from your garden and making an herb tea to cleanse your bowels of all their toxins, then you’re just asking for trouble.

    “Off-label drug prescriptions?”

    Also depends. There are many off-label uses that were proven in trials but weren’t approved by the regulatory bodies for one reason or another. And even if a particular use hasn’t been proven, there’s still room for doctors to innovate. Someone close to me has a prescription for an anti-inflammatory steroid that you’d normally use with a nebulizer. But the doctor suggested she simply pour the vial into her daily sinus rinse instead.

    “Anything that hasn’t passed a double-blind clinical trial… like parachutes?”

    Essentially yes, though the strictness of the test is a bit flexible. Some experiments are infeasible or impossible to do double-blind. Other experiments are so sensitive you even need to triple-blind. Things that anyone can prove to themselves (e.g. gravity) don’t need as much rigor either. Extraordinary claims demand extraordinary evidence.

    If you make a claim that seems to defy currently accepted facts, you need to make a really good case. Any alternative medicine that has nothing behind it but anecdotes deserves little respect. Same goes for claims that have a few weak studies in support but mountains of evidence to the contrary.

  49. Max says:

    Speaking of a sinus rinse, didn’t yogis figure it out centuries ago? It makes sense, it’s time-tested, and the results are obvious. It’s like a parachute. The anecdotal evidence of someone landing safely from 10000 feet is pretty damn convincing. No double-blind trial necessary.

  50. “Speaking of a sinus rinse, didn’t yogis figure it out centuries ago? It makes sense, it’s time-tested, and the results are obvious.”

    Exactly. For the purposes she’s using it, the effects have been proven. She suffers from specific symptoms that are treatable with rinses. There are known mechanisms that explain how it works. However, some people have taken it too far. I know a few people who use “preventative”/cure-all sinus rinses, which are at best ineffective and at worst harmful.

    And actually, the results aren’t particularly obvious, either. In her case, the only manifestation is pain. Pain is a highly subjective experience, so it’s easily fooled by placebos. People would be better off buying sugar pills… They’re much cheaper…

    “It’s like a parachute. The anecdotal evidence of someone landing safely from 10000 feet is pretty damn convincing. No double-blind trial necessary.”

    It’s not like the parachute at all. Parachutes have objective manifestations. You can test them with inanimate objects at various scales. We can explain how they work with physical principles. And it’s not anecdotal when anyone can easily reproduce the effect with a piece of paper and some string.

  51. Or witness someone else parachuting first-hand…

  52. Richard Smith says:

    For those who feel that the term “alternative medicine” gives the woo unwarranted legitimacy (I find myself leaning towards that opinion, myself, considering that popular skeptical Q&A, “What do you call an alternative medicine that works? Medicine.”), I propose the addition of two or three letters: “alternative(s) to medicine.” Doesn’t even mess up the acronym since words like “to” usually get left out.

  53. The Blind Watchmaker says:

    One can due a retrospective comparative study on the number of people who survived falls from great heights with parachutes and without. I predict that the results would easily reach statistical significance.

  54. Henk says:

    Gee, if you all had the conviction that Steve does you should go to your health food stores and pharmacy mart and read each sentence on each bottle of woo.

    Sufffice to say, i have to go further and further for my pharmaceuticals.

    If you look like an old fat retired hippy (like me) you can debate these quacks at folk festivals. Its best to carry an old washburn and sing the ode to ephedra as you make points.

    Hail felllow garden gnomes.

  55. Justine says:

    is there a way to become a content writer for the site?

  56. Radley says:

    The economy makes it so hard to make these choices.

  57. Radnor says:

    I wanted to comment and thank the author, good stuff

  58. Dillion says:

    It seems like something is missing, no?

  59. Jeff says:

    It’s bad enough when desperate and/or gullible people go the ‘alternative’ route, but when they subject children or pets to it, it becomes a crime. Kids get prayed to death on a regular basis in the US under cover of ‘respect for religion’, and recently I discovered that PETCO sells homeopathic ‘remedies’ for pets! The dirtbags who sell this crap can be found at http://www.homeopet.com. Just imagine how many animals are getting no treatment for potentially dangerous conditions because their owners are idiots!

  60. led tv says:

    Just grabbed the feed… thanks for posting this.

  61. Nancy Malik says:

    Studies in support of Homeopathy published in reputed journals

    1. Scientific World Journal

    http://www.ncbi.nlm.nih.gov/pubmed/17982565

    2. Lancet

    http://www.ncbi.nlm.nih.gov/pubmed/9310601

    3. Neuro Psycho Pharmacology
    http://www.nature.com/npp/journal/v27/n2/abs/1395862a.html // Bacopa Monnieri for memory

  62. Nancy – what you are doing is called cherry picking, looking at only a small subset of data. When all homeopathic studies are examined it is clear that there is no pattern of a real repeatable effect – there is no effect from homeopathy.

    Also, I looked at the first study you cite – it’s total crap. There is no indication that the assessment was carried out with proper blinding. An unblinded study like this is worthless. Further, they did multiple comparisons and found slight differences only in a few of them, but not the rest. This is also not legitimate – it is called multiple comparisons, and they did not do proper statistical adjustments for making multiple comparisons. Essentially, their results are random noise and they cherry picked the positive points.

    Those are the kinds of studies offered as evidence for homeopathy – totally worthless.