Does alternative medicine work? Or does it harm patients?

In a scathing review, the Associated Press reports that $2.5 billion in federal funding has been spent on researching alternative therapies.

None have been conclusively shown to work.

Despite this, more medical schools and hospitals are embracing alternative medicine, and in some cases, offering them to patients who are gravely ill. Also, health insurers are making deals to provide alternative services, as well as nutritional supplements, to their members.

The main reason why patients are flocking to alternative medicine is their current disenchantment with traditional, allopathic medicine. And I can’t say I blame them. The current health system forces doctors and hospitals to see and treat as many patients as possible, so they can stay financially viable. With shorter appointment times, it’s no wonder why both patients and physicians are dissatisfied with conventional health care.

But that’s not a reason to embrace alternative care. Not only have they been shown not to work, the lack of FDA regulation surrounding supplements means that some of them may actually harm patients, or are laced with prescription drugs. In fact, the president of an independent lab that tests such products says, “one out of four supplements has a problem.”

And worse, those who shun traditional medicine may be missing their last chance at treatment. For instance, “Cancer patients can lose their only chance of beating the disease by gambling on unproven treatments. People with clogged arteries can suffer a heart attack. Children can be harmed by unproven therapies forced on them by parents who distrust conventional medicine.”

This is a pretty important investigative report, one I recommend everyone to read.

And if there’s a bottom line to remember, it’s this: “When it says ‘natural,’ the perception is there is no harm. And that is just not true.”

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  • http://www.impactednurse.com impactednurse

    There is no such thing as ‘alternative’ medicine. There is just medicine. Now what we need to ensure is that it is evidence based.

  • Neil

    I would also be hesitant to say that the rise of “alternative medicine” stems from disenchantment with “traditional” medicine. Evidence-based medicine in it’s current form has only been around for 40 years, and physicians were prescribing leeches and placebos this century (and they still use steroids as a magic draught to battle bad humors with little or no evidence). And research into CAM uses the same misleading surrogate endpoints as most research today. We should focus on why people want alternative medicine instead of proving it’s inefficacy.

  • Jerry

    KevinMD refers to another distorted, one-sided piece by the AP’s Marilynn Marchione. In another recent article, she wrote this:

    “Millions of Americans take vitamin, herbal or other dietary supplements. Annual sales exceed $23 billion, and more than 40,000 products are on the market. Tens of thousands of supplement-related health problems are handled by U.S. poison control centers each year, according to a report in the New England Journal of Medicine in 2002. Until last year, supplement makers were not required to report problems to the FDA, and even now they must report only serious ones. The agency estimates that more than 50,000 safety problems a year are related to supplement use.”

    However the figures released by the American Association of Poison Control Centers (on their website) tell a different story.
    The AAPCC reports that in 2007 they received a total of 3,100 exposure calls for all catagories of dietary supplements: vitamins, minerals, amino acids, herbal preparations. Exposure calls are non-administrative, non-information calls; the caller was concerned about an exposure to a substance. Typically about 10 percent of these result in adverse events (requiring medical attention). Also In 2007 the AAPCC attributes a grand total of three deaths to dietary supplements.

    The supplement industry has an excellent track record of safety–something its critics simply refuse to admit.

    The FDA has all the legal authority it needs to remove supplements contaminated by pharmaceuticals, or those making false claims–especially ones relating to weight loss.

    There are decades of research proving that many supplements can improve health. This is research you will never read about in any piece by Marilynn Marchione.

  • http://erikpaul.net Erik Gulbrandsen, D.O.

    I would hope that you correct your statement above. You stated “disenchantment with traditional, allopathic medicine. ”

    This statement pits allopathic medicine on one side of the line and all others on the other side. This is a mistake.

    Osteopathic medicine has EBM on its side. Research shows it to be effective, especially for one of the most frustrating chief complaints, “low back pain”.

    OMM (osteopathic manipulative medicine) is a mainstream treatment and is not considered alternative.

    I would recommend that you rewrite your post to read: “disenchantment with traditional, allopathic/osteopathic medicine.”

    I read your blog everyday and I enjoy your comments.

    Thanks!

  • William Hsu

    Starting off, I would like to say that I think most of benifits of alternative medicine is simply placebo effects.

    But you know what, placebo effects can be benificial to patients. If you percieve yourself to be less sick, what’s the difference to the patient whether it came from evidense based medicine or alternative medicine. I think the medical establishment should embrace alternative medicine to a degree because it often provides patients with the mental state of mind that will make them feel better. Placebo effects are better than doing nothing.

    As long as the placebo is safe, you can afford it, and you’re not using it to replace evidense based medicine- the harm is minimal. The real issue is making sure the placebo is safe- this is where doctors need to step up.

  • Lily

    I always thought alternative medicine was BS, but then I was diagnosed with something for which there is no “conventional” treatment. Conventional medicine tells me that I have a disease that may or may not kill me, and that all I can do is wait and hope. I’m sorry, but I’m just not willing to take that as an answer. When I suggest to my doctor prescription drugs that are used to treat similar diseases, they always tell me that the drugs are not proven to work for my condition. I’m willing to give them a shot, but my doctors refuse to prescribe them.

    The only alternative I have is pumping myself full of supplements. I’ve started with vitamins and a few other that have generally been shown to be safe, so hopefully they won’t harm me. If these don’t work, I will try something else. I would much prefer conventional medicine and something with a proven outcome! It’s simply not available to me.

  • K

    “I would also be hesitant to say that the rise of “alternative medicine” stems from disenchantment with “traditional” medicine.”

    I have turned to “alternative medicine” because of my disenchantment with “traditional medicine.” My experiene with traditional medicine is that you have condition x and we are going to treat it with treatment y. Traditional medicine focuses on being free of disease instead of enhancing wellness. There is little discussion with MD’s on quality of life issues and I have turned to alternative medicine.

    My MD is the one who pushes the vitamins. I find the evidence is lacking concerning megadoses of vitamins that my MD inists I take.

  • David Block MD, PhD

    So here’s what folks are saying:
    1) It’s not the number of “appointments” but it’s what you DO in the appointment time. And “time” is not be the significant factor. Doc, if you ain’t got it, you ain’t got it, regardless of where you went to med school and did your residency. But, rather, look to…
    2) “Evidence Based Medicine.” However, it is quite meaningless unless the doctor and the patient cooperatively determine a testable hypothesis/-es at the highest level of pathophysiological specificity, regardless of what your favorite pathophysiology is. That is, whether you’re an DO (I understand being touchy, Eric; you guys have been the red-haired stepchild of academic allopathic physicians who thought that K(m) was enough in the lab and at home – and so screwed and skewed the lives of a million doc’s over the past 60 years), a DC (I’ll take an honest, thoughtful DC over an asshole MD/DO, and so would you), a naturopath, a TCM-ener, etc.: if you can’t formulate that testable, falsifiable hypothesis (i.e., a “diagnosis”), all we really want to see are your shiny elbows and Ralph-Laurened buttocks as you run out of town. You see…
    3) There is a big difference between a “disease” and an “illness,” although there is overlap. K and Lily see this. You “manage a disease” the way you calculated a yield in Quant to get yourself into the med school of your dreams. You don’t “manage” people who are sick – try it with your kids, your spouse and your lover (not at the same time) and see how well you do. You listen, you empathize (who let that damn word in?), you create an alternative future where “health” and “wellness” and “functionality” make sense. (Yes, logical sense). In the end…
    4) Just as Dr Seuss told us, and then we tell our children even as we ourselves forget immediately thereafter in spite of making our voices high-pitched and sing-songy and ever so sincere, “A person’s a person no matter how small.” So we forgive the kangaroo who just about wiped out an entire culture (and a talking elephant), but we sure do love to smack the crap out of each other. A little more time with Dr Seuss, a little less time with Dr Proudfart.
    David Block MD

  • Kim

    I think Lily demonstrates a big reason people turn to CAM: it provides people with a feeling of agency in dealing with a condition (including in some cases the “condition” of daily life and aging).

  • k (not that K)

    I think the issue here is time. Many physicians (especially primary care and internal medicine docs) just don’t have enough time…time to spend with the patient, talking meaningfully to the pt like s/he is a rational, thinking being, discussing various treatment options and why they may/may not be worth looking into, etc.

    In my experience, many providers of so-called complementary and alternative medicine (especially those who are cash only – no insurance company BS to put up with) spend much more time with their patients. Whether the treatment is beneficial or placebo, the pt feels as though they are taking a more participatory role, because the provider spent meaningful time with the pt. That goes a long way toward making someone feel better.

    Unlike (the other) K, I am fortunate to have physicians who treat me like a person rather than a disease (I have a couple of chronic conditions), and consider my thoughts instead of rejecting them out of hand. Their goal is my wellness. They really don’t want to see me more than a couple times a year – they’ve got really sick people to take care of..

    I’ve become disenchanted with sCAM practitioners. Many of them seem far more interested in maximizing sales, whether it’s supplements or return visits, with my wellness being secondary to their bottom line. As far as supplements go, you really don’t want to know how they’re made (I did some contract work at a supplement manufacturer’s plant/warehouse. Conditions there made me shudder.)

    @Lily – fire your doctors and find some who will work with you! The University of Wikipedia is not the place to look for answers, though. Do your research at PubMed and similar sources.

    @Dr Gulbrandtsen – You’re the first DO I’ve ever heard mention manipulation. (I used to go to the local osteopathic college’s clinic – docs there never said a word about it.)

  • lilly

    very small minded view. what are you defining as alternative medicine? integrative health, nutrition, meditation etc have all been proven to work. there is loads of research to support this. naturopathic med; eastern med.. it doesnt have to be one or the other but rather the integration of eastern/western medicine. as they say – for prevention, go eastern. for acute, western may be more beneficial.

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  • Lily

    k (not that K): I have fired my doctors . . . I am on doctor #5 who is, I believe, the only expert on my condition in the entire world. She’s currently doing a clinical trial, but unfortunately, I am not eligible for it. I try at every appointment to get her to inject me with her experimental medicines, but she’s too ethical for that. I just hope it’s proven to work and gets FDA approval, but that probably won’t happen for 5 years at least. I go in every 3 months for some pretty extensive follow up tests, but as for actual treatment, there is none available.

    So, I’m stuck with complimentary and alternative medicine and a nutrition plan that includes lots of broccoli and spinach. I’m hoping it just keeps me healthy long enough for the “real” medicine to be available!

  • Sharon MD

    As stated above, it depends how you define “alternative therapies.” Plenty of complementary therapies have been shown to work. Mindfulness classes, for instance, have shown increases in survival time after a diagnosis of cancer. Fish oil pills decrease LDL and increase HDL. Acupuncture has lots of evidence behind it (although most of the rigorous studies show no difference between sham acupuncture and “real” acupuncture, both methods are clearly superior to no treatment.) Lots of herbal treatments have good evidence behind them; for instance, vitamin B6 for hyperemesis gravidarum or peppermint oil for IBS. Some of these treatments are used quite frequently; does that mean they’re no longer “alternative” or “complementary” since they’re entered the mainstream? In addition, we spend plenty of money researching *conventional* therapies that don’t end up working and are found to be harmful.

    One of the problems with things like herbal remedies is, as you mention above, the lack of regulation of those sold over the counter. If I recommend an herbal therapy, I can’t know for sure what’s in it or how much. But this could easily be fixed by having FDA oversight of herbal supplements.

    I agree that many laypeople see alternative medicine as a panacea, and that can certainly be harmful if they delay conventional treatment. But we don’t need to throw the baby out with the bathwater just yet.

  • Bill

    I think we all know that human beings have been treating disease with natural medicine since the beginning of human civilization. We also know that western medicine has been in exsistance for a very short period of time and to think that we used leeches and other deadly means of practicing medicine since the beginning of western medicine. Today, we all know that perscription drugs (approved by the FDA) have more dangerous side effects than the condition being treated. In other words, for example.. take a pill for a skin condition and possibly die from a heart attack. We as human beings can see the truth for what it is. In most cases western medicine is more unevolved and uses more quakery than the natural medicines we have been using with great results since the beginning of time. Of course the FDA will continue to shoot down natural medicine, They have nothing to gain by approving it.

  • Bill

    Evidence based medicine…Is the pure evidence that patients are being treated with CAM and loving it. The evidence is in the countless patients who believe in and are being healed from their symptoms with little to no side effects whatsoever. Converlsy, countless patients are dissatisfied with pharma, the side effects, and the results from their western treatments. Why is AMA so afraid to integrate the two medicines together for the treatment of patients? Why does the FDA keep doing whatever they can to try to disprove that natural medicine works. The proof is in the patients.

  • http://fertilityfile.com IVF-MD

    In our field, CAM is OK to try and experiment with as along as it’s not harmful. But keep in mind that harm comes in many forms. This could be physical harm, financial harm OR harm in terms of lost opportunity. If a 33-year-old woman with blocked tubes wants to try acupuncture, herbs, magnets, vitamin supplements, crystals, hypnosis and physical manipulation for a year each rather than doing IVF, even if those attempts don’t deplete her financially nor harm her physically, she will find herself to now be 40 years old and in a much worse prognosis category when she’s ready to do IVF.

    On the other hand, the good thing about the placebo effect for infertility is its unique property, that while the temporary placebo effect may go away after time, the positive consequences stick around. In other words, let’s say a couple have been childless for five years and they try aromatherapy and voodoo to try and boost their fertility. If the placebo effect results in a temporary boost in their monthly chance to conceive and they end up getting pregnant and having a baby, even if those effects fade away, guess what — they still have their baby.

  • http://roguemedic.blogspot.com/ Rogue Medic

    William Hsu,

    As long as the placebo is safe, affordable, and not used to replace evidence based medicine – the harm is minimal.

    The problem is that alternative medicine is often used to replace evidence based medicine. That is the basis for the name alternative. Some use complementary as a way of seeming to avoid that conflict. Still, when there is a good outcome, the credit is given to the alternative medicine. When there is a bad outcome, the blame is placed on the evidence based medicine.

    Why should we be treating patients with treatments that have no evidence to support them? Other than the rare, difficult to study, disease?

    Look at the case of Daniel Hauser. A mother takes her son and runs away to avoid a treatment that is over 90% successful. A treatment that has significant side effects, but is extremely successful. He is taking a treatment from the founder of an on-line religion. This healer is in between jail terms (I do not expect him to avoid further fraud, do you?). When they return, they continue with the alternative medicine and give all of the credit for the patient’s improvement to the alternative medicine.

    I do not see alternative treatments, which have no evidence to show that they are anything other than glorified placebos, as harmless. They will continue to be promoted as alternatives to evidence based medicine.

    We also need to require that conventional medicine be much more evidence based.

  • William Hsu

    Rogue,
    Lots of doctors treat alternative medicine as an “us vs them”. I think this is a grave miscalculation because as you stated there are people (i.e. daniel hauser) who would choose alternative medicine over evidense based medicine.

    Instead of digging trenches and fighting patients over thier choice of care, I think a more effective way of treatment is to work with what patients want. I’m chinese and i know tons of people who prefer eastern medicine. Instead of denouncing thier beliefs- you’re more likely to get better patient cooperation if you accept that they will use eastern medicine and try to convince them to use evidense based medicine in conjunction with whatever alternative treatments they use. Do i think it’s the best treatment possible- probably not. But i do think it’s better than not using evidense based medicine at all.

    Alternative medicine is “replacement medicine” only if you make it an either/or proposition. don’t fall into that trap.

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  • http://roguemedic.blogspot.com/ Rogue Medic

    William Hsu,

    Maybe this discussion of should be whether there is a place for placebos in medicine. Or whether there is a place for treatments with no evidence to support them. Aside from the conditions where research is very difficult due to small numbers of patients with the condition and other legitimate restraints on research.

    I don’t know of anyone who would object to using an alternative treatment that can demonstrate effectiveness, but the research has not been showing any more effectiveness than placebo and sometimes alternative medicine is less effective than placebo.

    Conventional medicine has a bit of the same problem. There are many treatments that do not have good evidence to support them. I do not think that we should encourage the use of wishful thinking medicine just because it is conventional, either.

    If Sen. Tom Harkin gets his way, we will be paying billions of dollars for all sorts of alternative treatments, just because he thinks it is a fairness issue. We should not be paying for ineffective treatments. If competent adults want to pay out of their own pockets, that is their choice. I see no reason to indicate, in any way, that alternative medicine is a good choice.

  • http://roguemedic.blogspot.com/ Rogue Medic

    Sharon MD,

    Acupuncture has lots of evidence behind it (although most of the rigorous studies show no difference between sham acupuncture and “real” acupuncture, both methods are clearly superior to no treatment.)

    I wrote about this misrepresentation of the research in Eureka – Conventional Treatment Plus Placebo Beats Conventional Treatment Alone.

  • William Hsu

    Rogue,
    As i stated in my first post, placebo effects are still effects- they work better than doing nothing at all. For example- sugar pills are often more effective in relieving pain than no pills. Lots of smart people forget this.

    I don’t know how placebos manage thier effects- if it’s a matter of “self fullfilling” prophesy, a trick of the mind mediated through internal opiods, self hypnosis or some other random thing- but placebos are effective, they just happen to be as effective as every other placebo.

    The funny thing about placebos is they have to make patients believe in them to work. They wouldn’t work on me cause i don’t believe in most alternative medicines. But for some people, alternative medicine provides them with that belief that they’ll get better. Listen, i’m not going to explain or endorse specific placebos, but i’m not going to fight patients over them as well. Placebos obviuosly put many patient in a state of mind that makes them feel better- it would be silly to take that away from them. Hope is a powerful mediator in health that doctors often ignore. A hopeful patient often tries harder, is less discouraged and is generally healthier.

    If a specific placebo is harmful, i’ll fight it, but otherwise i’ll accept the placebo effect- anything to make the patients feel better.

  • http://roguemedic.blogspot.com/ Rogue Medic

    William Hsu,

    As i stated in my first post, placebo effects are still effects- they work better than doing nothing at all.

    I agree. There would not be a difference in outcomes otherwise.

    I don’t know how placebos manage thier effects

    There are still people claiming that the placebo effect is a myth, so explaining how it works is far from clear.

    but placebos are effective, they just happen to be as effective as every other placebo.

    I think there have been studies that show that the type of placebo influences the effect. A pill has less of a placebo effect than something more involved, or one involving more manipulation of the body.

    The funny thing about placebos is they have to make patients believe in them to work. They wouldn’t work on me cause i don’t believe in most alternative medicines.

    That is also unclear. There may be something other than belief involved.

    If a specific placebo is harmful, i’ll fight it, but otherwise i’ll accept the placebo effect- anything to make the patients feel better.

    I think that there is harm in telling people that magic works. We need people to understand science to deal with many problems in our future. Alternative medicine has a lot to do with the person believing that they have something special about them, or there is something special about natural treatments, or some other exemption from the real consequences of the real world. This is not at all healthy.

    Just look at Jenny McCarthy and Dr. Jay Gordon and others telling people to not vaccinate their children because a mother knows. This is the kind of illogical destructive thinking that come from belief in magic.

    Alternative medicine is belief in magic. A belief that although science keeps demonstrating that the treatment is no more effective than placebo, because the person taking it is a good person, with good karma, they will be healed by the magic. This is dangerous.

  • William Hsu

    Rogue,
    I’m rounding in surgery right now, so i really can’t dedicate much time on this anymore. I’m definately not going to go into a sentence by sentence citation fight with you. In reguards to all your sentence by sentence stuff- all you really did was cast doubt on my claims, you never outright refuted them. If you don’t think placebos effects exist or are not based off of mental perceptions and belief, i’m open to hear your theory. But I think most popular scientific theories on placebo effects (based off the 3 neuropsych class i took in college) is based off the concept that expectation(aka belief) mediates part of the placebo effect.

    I think the main difference between you and me is that you want to convert patients to your way of thinking, while i’m resigned to the fact that certain patients don’t think scienfically (Jenny McCarthy and other random people), and i’m willing to work with that.

    Don’t get me wrong, I would love all patients to think more scientifically- but it’s not happening in the near or distant future. The brain’s natural state is to recognize patterns(think skinner box experiments)- this is where the emergence of magical thinking occurs. You’re never going to extinguish magical thinking completely- it’s the brain’s basal state(remember kids start off with magical thinking). I think you’re fighting an uphill battle.

  • http://roguemedic.blogspot.com/ Rogue Medic

    William Hsu,

    If you don’t think placebos effects exist or are not based off of mental perceptions and belief, i’m open to hear your theory.

    I don’t see where I denied any placebo effect. As for it requiring belief, all I wrote is That is also unclear. There may be something other than belief involved. I was not clear enough. I should have written, there may be more than just belief involved in the placebo effect.

    You’re never going to extinguish magical thinking completely- it’s the brain’s basal state(remember kids start off with magical thinking). I think you’re fighting an uphill battle.

    I agree.

    I think that we need to work to improve the understanding of science. Uphill battle, or not, educating people about science is a good thing.

    I would much rather have people complaining that I am spending too much time trying to explain science, than not enough.

    Even a lot of doctors have been misinterpreting research. My reply to Sharon MD, about the study she referred to, is just one case of this. Sharon MD is not the only MD to misinterpret the results. Medscape reported the results as mininterpreted by the authors.

    We should be encouraging a better understanding of science. That does not include encouraging magical thinking. Or, I should say, that does not include discouraging children from outgrowing magical thinking.

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