Alternative Medicine: a skeptical look
Prof Steven Novella, MD-Neurology,
Yale University School of Medicine and Advisory Board, Quackwatch
This is the recap of a talk given at the June 8, 2003 CDHS monthly meeting.
Prof. Steven Novella, MD, talked to us about Alternative Medicine: a skeptical look.
Prof. Novella is Assistant Professor of Neurology, Yale University School of Medicine, President, The New England Skeptical Society, Associate Editor, The Scientific Review of Alternative Medicine and the Scientific Review of Mental Health Practice, and a member of the Advisory Board of Quackwatch and the American Council on Science and Health.
Prof. Novella started with his conclusion: The dichotomy between alternative and conventional medicine is artificial and confusing. It should be given up.
"Medicine is what works," the best methods known should be used. Any kind of medicine which adheres to this maxim is to be taken serious.
How did medicine develop? - A (very concise) history:
In the early ages, we find mystical-based medicine. Health was believed to be controlled by supernatural forces and medicine was practiced by priests. There are still remnants of this type of medicine in present time.
Philosophy-based medicine emerged in the classical cultures of Greece and Rome. Illness was understood on the basis of philosophical hypotheses. There was no systematic experimentation but observations were collected and a medicine literature accumulated. In parallel, there existed a practical medicine based on herbs, and midwifery. Not much changed until about 150 years ago, 150 years after modern science (astronomy, physics, engineering) emerged, giving rise to. . .
Science-based medicine, meaning that diseases were recognized as such, diagnosed and treated in a systematic and measurable way. At first, the methods frequently failed, but knowledge accumulated rapidly. Basic or pre-clinical methods as well as clinical treatments were developed and constantly improved scientifically using success in the treatment of the disease as the main yardstick resulting in a. . .
Standard of Care on the basis of a hierarchy of treatments: starting with proven methods known to be successful in a majority of cases and having minimal side-effects, to modified treatments, and finally to more risky, new methods as the last resort. This scheme applies to all medicine.
There are medical approaches which do not adhere to this standard of care. They form the vast group of Complementary and Alternative Medicine (CAM).
The practice of medicine is regulated by the States. Unfortunately, in many states, any type of CAM can be practiced, as long as it is labeled as a CAM, to the point it causes injury or death. The same judicial philosophy applies to pharmaceuticals. As long as a drug or "nutritional supplement" does not explicitly claim to cure a disease, it does not need FDA approval and can be traded without restrictions. This is a consequence of the Nutrition Labeling and Education Act, fully enacted in 1994, leading to the situation that the shelves now bend under vast number of all kinds of herbal and other nutritional supplements. By the way, homeopathic medication is FDA approved (traditionally) because it cannot do any harm due to the ridiculously low concentrations of the active ingredients.
What characterizes CAMs? They typically attempt to explain health and all diseases as caused by a single principle or condition, e.g. unbalance of energy (whatever that means) and its flow, nutrition, toxins, spleen, vertebrae (Chiropractitioners), etc., or use one type of "diagnostics", like iridology (looking at the iris) , pulse analysis, hair analysis, and many more. Consequently, treatment is based on this monolithic belief with no choice. These principles range from the pseudo-scientific (e.g. nutrition, acupuncture) to the downright absurd (e.g. homeopathy).
Science-based medicine has learned that there are many causes of disease: Infection, genetics, trauma, failure of the immune system, vascular, degenerative to name a few, and, not to be forgotten, idiopathic, meaning "no known cause". There are many diagnostic tools and, of course, the hierarchy of treatments. CAM is united in bashing the "establishment" (the medical profession) for being either preoccupied, narrow-minded, resisting progress, hungry for power, greedy, conspiring, or ignorant, to name a few. There is also the allegation that our mainstream medicine is white- or European- dominated (which is asserted to be politically bad). This applies particularly to the anti-scientific wing of the CAM whereas the more moderate pseudo-scientific wing pretends to be based on science but actually does not comply with the rules of the scientific method.
You will never find admission of failure. Pseudo-scientific misinformation is used to explain failure away. On the contrary, the report of successes is bases on anecdote and testimony, both inadmissible as scientific evidence.
It cannot be denied that there are cases where CAM modalities seem to work. This situation is closely linked to the Placebo Effect, which can be defined as "any apparent effect of an interaction other than the physiological response the treatment was aimed at," going much farther than what most people understand by the Placebo Effect. As some of the many causes of the Placebo Effect, Prof. Novella named investment justification, that most illnesses go through a phase of improvement or are self limiting, or the desire for hope.
He concluded by suggesting education and regulation as measures to curb the provision of health services which generate false hope and are potentially dangerous because they can defer treatment which adheres to the Standard of Care until it is too late, or at least lengthen the period of suffering unnecessarily. He also advised that the Nutrition Labeling and Education Act in its present form should be repealed so that nutritional supplements fall under the control of the FDA.
In the following question period, Prof. Novella answered quite a number of questions, among them on acupuncture and how patients who believe in a CAM - if they find their way to a traditional health providerís office - can be reeducated.
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