by Stephen Barrett, M.D.
"Alternative medicine" has become the politically correct term for questionable practices formerly labeled quack and fraudulent. During the past few years, most media reports have contained no critical evaluation and have featured the views of proponents and their satisfied clients. These happenings are part of a general societal trend toward rejection of science as a method of determining truths.
To avoid confusion, "alternative" methods should be classified as genuine, experimental, or questionable. Genuine alternatives are comparable methods that have met science-based criteria for safety and effectiveness. Experimental alternatives are unproven but have a plausible rationale and are undergoing responsible investigation. The most noteworthy is use of a 10%-fat diet for treating coronary heart disease. Questionable alternatives are groundless and lack a scientifically plausible rationale. The archetype is homeopathy, which claims that "remedies" so dilute that they contain no active ingredient can exert powerful therapeutic effects. Blurring these distinctions enables promoters of quackery to argue that because some practices labeled "alternative" have merit, the rest deserve equal consideration and respect. Enough is known, however, to conclude that most questionable "alternatives" are worthless.
The "alternative movement" is part of a general societal trend toward rejection of science as a method of determining truths. This movement embraces the postmodernist doctrine that science is not necessarily more valid than pseudoscience. In line with this philosophy, "alternative" proponents assert that scientific medicine (which they mislabel as allopathic, conventional, or traditional medicine) is but one of a vast array of health-care options. Instead of subjecting their work to scientific standards, they would like to change the rules by which they are judged and regulated.
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. Instead of conducting scientific studies, they use anecdotes and testimonials to promote their practices and political maneuvering to keep regulatory agencies at bay.
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.
A British study has demonstrated how belief in an ineffective treatment can lead people to overestimate its effectiveness. In 1986 personnel at Bristol Cancer Help Center felt a need to validate their program of counseling, "healing," a vegetarian diet, homeopathy, acupuncture, and various other therapies they believed would enhance quality of life and foster a positive attitude. At their invitation, a research team compared the course of 334 of the center's breast cancer patients and 461 similar patients treated at mainstream hospitals during a 16-month period. Survival times and metastasis-free periods were significantly shorter among the center's patients.
Many "alternative" approaches are rooted in vitalism, the concept that bodily functions are due to a vital principle or "life force" distinct from the physical forces explainable by the laws of physics and chemistry and detectable by scientific instrumentation. Practitioners whose methods are based on vitalistic philosophy maintain that diseases should be treated by "stimulating the body's ability to heal itself" rather than by "treating symptoms." Homeopaths, for example, claim that illness is due to a disturbance of the body's "vital force," which they can correct with special remedies, while many acupuncturists claim that disease is due to imbalance in the flow of "life energy" (chi or Qi), which they can balance by twirling needles in the skin. Many chiropractors claim to assist the body's "Innate Intelligence" by adjusting the patient's spine. Naturopaths speak of "Vis Medicatrix Naturae." Ayurvedic physicians refer to "prana." And so on. The "energies" postulated by vitalists cannot be measured by scientific methods.
Although vitalists often pretend to be scientific, they really reject the scientific method with its basic assumptions of material reality, mechanisms of cause and effect, and testability of hypotheses. They regard personal experience, subjective judgment, and emotional satisfaction as preferable to objectivity and hard evidence.
"Alternative" practitioners often claim that their approaches promote general health and are cost-effective against chronic health problems. However, there is no published evidence that they are more likely than mainstream physicians to persuade their patients to adopt a healthy lifestyle. Nor have any vitalistic approaches been proven effective or cost-effective against any disease.
During the past few years, the news media have publicized "alternative" methods in ways that are causing great public confusion. Most of these reports have contained no critical evaluation and have featured the views of proponents and their satisfied clients. Many have exaggerated the significance of the National Institutes of Health (NIH)'s recently opened Office of Alternative Medicine (OAM). Creation of this office was spearheaded by promoters of questionable cancer therapies who wanted more attention paid to their methods. Most of OAM's advisory panel members have been promoters of "alternative" methods, and none of its publications have criticized any method. In 1994, the OAM's first director resigned, charging that political interference had hampered his ability to carry out OAM's mission in a scientific manner. The OAM has funded about 50 studies related to "alternative" methods. However, it remains to be seen whether such research will yield useful results. Even if it does, the benefit is unlikely to outweigh the publicity bonanza given to questionable methods.
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Stephen Barrett, M.D., a retired psychiatrist in Allentown, Pennsylvania, is a nationally renowned author of 42 books, editor, and consumer advocate. An expert in medical communications, he is medical editor of Prometheus Books and consulting editor of Nutrition Forum, a newsletter emphasizing the exposure of fads, fallacies and quackery. Dr. Barrett is a board member of the National Council Against Health Fraud, a Scientific Advisor to the American Council on Science and Health, and a Fellow of the Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP).
This article is reprinted with permission from the author.