Why alternative care seems to work

People sort of want to try alternative care.  They’re working up to it, but then they read more about it; they read about the theory and they say, “No I don’t believe that theory.  That can’t possibly work.  There’s nothing to it. I’m not going to do it.”  But, the problem is that the theory of why something works or the explanation is not necessary related to the effect of how things actually work.

Here’s a simple example. Suppose I believe that light is a liquid, and it travels in pipes in the wall.  And I believe that when you turn on the light switch, the light travels up the pipes in the wall, over the ceiling, and comes out of the light bulb and radiates/evaporates light into the air.  Is that true? Is that a good explanation of light? Probably not!  But that doesn’t mean that the light switch doesn’t work for me.  If I turn on a light switch it’s going to work no matter what I believe about how the light comes out of the fixture in the ceiling.

And so let’s think about alternative care that way, and let’s just take two common examples. Chiropractic:  Many, many millions of people use chiropractic and are happy with it. The explanations for chiropractic are originally related to vertebral subluxations (which can’t be noticed on xray) that somehow interfere with nervous transmission in the body causing all kinds of problems.

You don’t have to believe that necessarily to go a chiropractor and get help for your back pain.  In fact, many people don’t even care about the explanation; they just go to the chiropractors and get help.  So, the explanation and the effect are not the same or not necessarily even related.

The same is true, I think, of acupuncture, which is another common modality — increasingly common in the western world — that was really developed in ancient China in a prescientific era.  The Chinese developed these theories of energy flow (or Ch’i) in the body, along channels related to meridians; and all of that define the practice of acupuncture.

There’s no scientific basis for any that.  None of it can be measured as far as we know, in our scientific world today.  That’s a totally separate question than, “Will the practice of acupunc­ture help my pain get better?” or help me feel better, or help me with my problem.  And many, many people are accepting that acupuncture works for them.  It doesn’t mean necessarily that it works in the way that it has been traditionally explained for thou­sands of years.

So this is kind of what I’m talking about.  Don’t get so hung up on the explanation that you don’t believe in, that you’re unwilling to try a practice that might actually help you.  Just keep an open mind.  You don’t have to know everything about how things work; you just have to know that they work. Just like, do I really understand electricity or do I just know that if I turn the light switch, the light comes on?

A good example, I think from western medicine is this drug Lunesta.  You’re probably familiar with it.  It’s the little butterfly that flies around on the commercial while the lady is trying to get a good night sleep and the commercial talks about how Lunesta can help you sleep.  And at the very end of the commercial, the very very end, there’s this little statement, something like, “The mechanism of action of Lunesta is unknown” or “How Lunesta actually works is unknown.”

Or, “We just don’t know how this stuff works basically.”  So, this is a widely prescribed drug, market leading drug, many many doctors are writing for it, the drug company is making it, the FDA has approved it, and no one knows how it really works!  We just know it helps people sleeps.  That’s okay.

Transfer that theory into alternative care.  We don’t know how all those practices work either but they seem to work to help people. So free up your mind a little bit. Don’t get hung up by explanations that don’t make sense to you.  If you think the practices are safe and they might help you, open your mind a little bit give them a try. Leave the explanation behind and do what works for you.

Peter J. Weiss is an internal medicine physician and former health plan CEO.  He is author of More Health Less Care and can be reached at More Health, Less Care: Building America’s Wellness System.

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  • http://www.manuellterapi.org Vegard Olstorn

    Thanks for an interesting post.
    Quote: “Don’t get so hung up on the explanation that you don’t believe in, that you’re unwilling to try a practice that might actually help you. Just keep an open mind.”

    Does my unwillingness to try something, even if thousand people says it works, mean that I do not have an open mind?

    From my point of view this video gives a great explanation: http://www.youtube.com/watch?v=T69TOuqaqXI

    Best regards,

  • Karen

    An MD that has never heard of placebo response? How can anyone justify sick, vulnerable and desperate patients wasting money on a treatment of any kind that has no efficacy other than placebo response. And to then let chiro and cam off the hook by saying; look here at Big Pharma does it so cam can too. Do you prescribe homeopathic medicine to your patients too?

    Denial of serious medical conditions is the greatest contributor to unnecessary death, increased medical expenditures and suffering in patients. The way cam scams and preys on this vulnerability is more than evident in this blog. EVERY person who seeks medical attention should receive, NO DEMAND, treatment based on science and evidence; not conjecture, anecdotes and wishful thinking.

    As for Lunesta, a search of PubMed yields a fair amount of current research on Eszopiclone: In Vivo Evidence of the Specificity of Effects of GABAA Receptor Modulating Medications. Andrew D. Krystal, MD, MS 2010.

  • Bobbo

    I’m fine with prescribing a drug with an unknown mechanism. However I will only do this if I have seen studies that prove the drug’s efficacy and safety. I don’t have a problem with alternative medicine, I have a problem with any therapy that lacks solid research proving efficacy above placebo (or other standard therapies) and safety.

    • Zach

      This is part of the problem. “Alternative Medicine” is an unnecessary term that only exists to create a double standard for products that don’t work. If an intervention is backed by solid research that demonstrates efficacy, then it is medicine, there is nothing alternative about it. There is medicine and there are those things that are not medicine. “Alternative” and “Complimentary” medicine are little more than a marketing term. It’s like referring to parapsychology research as “alternative science” or “complimentary science”. It’s silly indeed.

  • http://www.wix.com/psychologysolutions/psych David Pollak, Senior Psychologist

    This is a controversial topic, yet quite fascinating.

    It’s controversial due to widely varying views yet fascinating because society gradually moves forward with interesting advancements that really help people. Some advancements work and some don’t.

    One advancement that was once considered alternative but now generally considered scientifically supported with regular ongoing ressearch, is Psychologist services.

    For example, research continues to show how effective Cognitive Behavioural Therapy is. It was once used to treat depression and is now used for a wide variety of concerns from workplace stress to personality disorders.

    Someone at some point must have kept an open mind. It is unclear if Dr Aaron T Beck (it was Beck’s ideas and research that helped develop CBT) fully envisioned how useful CBT really is and the extent to which patients/clients can now benefit from it.

    Our Psychologist service uses only evidence-based approaches to make sure we use tried and tested interventions. We do also keep an open mind, because it is important to give new ideas a chance because one of them may one day become part of our accepted way of life.

  • http://www.onehealthnow.org A Boston Acupuncture Student

    Thank you for the post Dr. Weiss. It resonates with me on many levels.

    To Karen, before you claim “no efficacy” on CAM, maybe you’d be willing to take a walk through the evolution of acupuncture research and adopt a more informed viewpoint.

    I would point you to Robert Becker in 1976 (conductivity along acupuncture meridians relating to points); Soeren Ballegaard in 1993 (acupuncture modulation related to heart-rate); Helene Langevin in 2002 (fascial plane mechanotransduction); Zang-hee Cho from 2002 on (the physicist who pioneered use of fMRI imaging of the brain to examine acupuncture’s effects).

    Also check out the works of Nina Theysohn, Maiken Nedergaard, and retired Air Force Colonel Richard Niemtzow.

    What you find may surprise you.

    Respectfully,

    ABAS

  • Karen

    ABAS My respects to you and Boston, great city.

    II would point you to the great work on skin by Elaine A Lumkin. PubMed. Nature. 2007 Feb 22;445(7130):858-65. Mechanisms of sensory transduction in the skin. Lumpkin EA, Caterina MJ.

    Helene Langevin http://pubget.com/search?q=authors%3A%22Helene%20M%20Langevin%22
    Review Article 2011
    Paradoxes in Acupuncture Research: Strategies for
    Moving Forward Helene M. Langevin,1 PeterM.Wayne,2 HughMacPherson,3 Rosa Schnyer,4 RyanM.Milley,5 Vitaly Napadow,6 Lixing Lao,7 Jongbae Park,8 Richard E. Harris,9
    Misha Cohen,10 Karen J. Sherman,11 Aviad Haramati,12 and Richard Hammerschlag5

    I refer you to the above paper; “Box 1: Summary of conclusions emerging from the 2007 Society for Acupuncture Research Conference∗ [3, 4].”
    Conclusions: “It is therefore vital to recognize the lack of clear difference between verum and sham acupuncture treatments in clinical trials, as well as the documented physiological effects of acupuncture needling in basic science studies.It is now the important responsibility of acupuncture researchers to face these results squarely and move the field forward.”

    J Altern Complement Med. 2005 Aug;11(4):719-22.
    Cochrane systematic reviews in acupuncture: methodological diversity in database searching.
    Sood A, Sood R, Bauer BA, Ebbert JO.

    BMJ 2009; 338:a3115 doi: 10.1136/bmj.a3115 (Published 27 January 2009) Cite this as: BMJ 2009; 338:a3115
    Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups.
    “Conclusions A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear.”

    I have an open mind it is the explanations that need work. I am just as critical of any manual therapy that puts pain in the tissues instead of in the brain. R Melzack, L Moseley, VS Ramachandran.

    Regards,
    Karen

  • http://www.foodandhealth.com doctorjay

    ABAS – Karen is correct that accupuncture is pointless scientifically. It works via the placebo effect as do most scam alternatives to drugs and surgery. Of course, CBT, diet, exercise, smoking cessation, etc. are often safer and potentially far more efficacious than prescription drugs and/or surgery for treating non-emergency health problems. The problem with those alternatives is mostly patient compliance rather than safety and efficacy. If you want to prevent a heart attack what the patient does is often far more important than presription drugs and angioplasty but if you are having a heart attack get to the ER a.s.a.p. because lifestyle change won’t help – but taking an aspirin on route to the ER might.

    In short there are science-based alternatives to drugs and surgery that really can work very well and there are things like accupuncture, homeopathy, and all sorts of quack cancer treatments like those advocated by Ms Summers (hint never get health advice from books written by ditsy actresses). Chiropractic is more complicated as it is a blend of silly theories and practical physical therapy that is often worth a try before resorting to drugs or surgery for back pain – most of which is self-limiting anyway.

    One should keep an open mind but not so open your brain falls out.

  • http://bit.ly/9wmOLT Dyck Dewid

    I appreciate your words Dr. Weiss. I’m glad Placebo affect was brought up in several comments. It addresses both the open mind issue and efficacy of something most of don’t know much about, consciously at least… the mind-body-spirit connection. (I realize many readers drop off at this point)

    The placebo proves beyond a doubt that for some mysterious reason the patient is enabled to heal herself. Yet, why do we not focus on understanding more about this enabling affect rather than our naive & arrogant propulsion to improve or rescue nature?

    To go inward into self, to recognize how our conditioning limits us, is not about education or skills. Its about deep yearning for truth & what is real. The need to understand self deeply comes when the time is right for a person- not before, not because someone wants to be smart, or because they’re testing or curious. Often it comes when a person faces their mortality. Many of us, no doubt, think we already know ourselves.

    When a question is asked perhaps we might let it simply remain open in ourselves. That way it remains alive, active, energetic, tickling our attention, gathering information as we live and notice. In this way we get pulled up into the question, rather than pulling the question down to fit our ready learned answers… and its consequential loss of vitality to defense & posturing & selling.

    The right questions are deep within (maybe we’re too busy doing important work to go there).

    • Zach

      I think you grossly misunderstand what the Placebo Affect is. The Placebo affect doesn’t cure anything or enable, in any way, the person to heal themselves. The Placebo effect has simply to do with the perception of a change. So this line: “The placebo proves beyond a doubt that for some mysterious reason the patient is enabled to heal herself.” is not even close to being true and this question: “Yet, why do we not focus on understanding more about this enabling affect rather than our naive & arrogant propulsion to improve or rescue nature?” is meaningless and doesn’t even make a whole bunch of sense.

  • gzuckier

    Well, it’s the consciousness which seeks treatment, and is treated, in the end. As is so well documented, the response to a particular physiological state depends highly on the “state of mind”; one patient will feel fine with a condition that floors somebody with a depressed state of mind; or even himself, later in time. Or the football player who plays the second half of the game with a broken leg, etc. etc.
    One definition of illness (from Wiktipedia): “the subjective perception by a patient of an objectively defined disease”
    and of course, “disease” itself, literally “Lack of a feeling of ease; uneasiness”
    so the question of mental control over bodily physiology is perhaps secondary to the question of mental control over the mind’s own attentions.

  • http://www.TheHealthCulture.com Jan Henderson

    According to a 1987 article on somatization (http://bit.ly/fVUGFG), psychogenic or somatoform problems represented at least 30 per cent of all complaints seen in primary care. A 1990 article (http://bit.ly/ebE4Q8) on somatization reports that, in any two-week period, nine out of ten people experienced symptoms, and the average adult had four symptoms of illness on one out of every four days.

    The symptoms of patients with somaticized complaints used to be ameliorated by doctors who had time to listen to and know their patients. Now that we have so many drugs, lab tests, and high tech machines, the doctor/patient relationship is no longer considered therapeutically necessary or important. Within medicine, we send those patients to psychiatrists who medicate them.

    In the future, the division of labor will be between medical doctors and alternative practitioners. Patients will enter their symptoms into computer programs that order diagnostic tests. Doctors will view the results on their own computers and prescribe further tests or medications for these electronic patients. Only surgeons will need to see patients in the flesh.

    Patients with somaticized complaints will be identified and directed to alternative practitioners or psychotherapists, who will have time to listen to the patient’s story and recommend lifestyle changes. For these patients, the placebo effect of an alternative practice will be just as effective as what an MD can offer.

    Far fetched?

  • Molly Ciliberti, RN

    Placebo effect is real.

  • Rob

    An extremely disappointing and ill-thought-out post. For an MD, this is a very naïve take on the controversial issue of CAM, which will only confuse the public further.

  • Joe

    The comparison of acupuncture to a drug (Lunesta) whose mechanism of action is unknown is baseless, wishful thinking. In clinical trials, a drug that is no better than placebo is deemed ineffective. The best acupuncture studies show it is no better than sham acupuncture (of many varieties); therefore it is ineffective. That is a fact.

    The difference between Lunesta and acupuncture is the drug has been shown to be effective in clinical trials and acupuncture has not. .

  • http://bit.ly/9wmOLT Dyck Dewid

    A pleasure to experience the learned and well intentioned people in this discussion. I enjoy it not simply to confirm or defend what I think I know. But, I’m learning from the diversity. Allow me to offer some additional, possibly converging & foundational material.

    A little deeper look at very simple stuff. Consider this.
    “Be Each Other’s Healthcare” (doesn’t include surgery), from founders of InterPlay.org an international nonprofit dedicated to body wisdom and play.

    Treating the body as an abstract problem to fix reduces health, joy, ideas, and love in individuals and groups. Nations? Yes. When the poor are ill, I am ill. When a prisoner is tortured, it comes back. When I treat earth as abstract, I become abstract. Connectedness is a fact. Our health depends on each other.

    So here’s a little Rx for being each other’s health care:….
    See more at “Be Each Others Healthcare:” http://bit.ly/9QWp2R
    ~
    “…civilized human beings are alarmingly ignorant of the fact that they are continuous with their natural surroundings. It is as necessary to have air, water, plants, insects, birds, fish and mammals as it is to have brains, hearts, lungs and stomachs. The former are our external organs in the same way the latter are our internal organs.” Alan Watts -Does it Matter

    No offense intended if this applies to you, as it did to me at one time (maybe time will allow it to pry the lid a little, to go deeper within). Appreciate responses.

  • http://scienceblogs.com/insolence Orac

    FYI, I’m very disappointed in you, Dr. Pho for posting something like this.

    http://scienceblogs.com/insolence/2011/03/say_it_aint_so_dr_pho_credulity_towards.php

    • Kevin

      Orac,
      I appreciate the critique. As readers of this blog know, I often post pieces here I don’t necessarily agree with myself to promote discussion and debate. Your concerns are certainly valid, and will be taken into consideration as I choose future pieces.

      Best,
      Kevin

  • http://scienceblogs.com/insolence Orac

    Post pieces you don’t necessarily agree with myself to promote discussion and debate? Give me a break! I didn’t want to believe it, but one of my readers commented that it looks like you’ve become all about the page views, traffic, and advertising. Your comment makes me think he might well have been correct.

    You appear to have lost your way from way back when six years ago. Sadly, I can no longer recommend your blog to my readers as a source of reliable medical information, and I will be removing it from my blogroll.

    • Kevin

      Sorry you feel that way Orac. Once again, I appreciate your comments and critique. Keep up the great blogging.

      Best,
      Kevin

  • Fred

    Dr. Steven Novella has written his analysis of this article on him NeuroLogica blog:

    http://theness.com/neurologicablog/?p=2905

  • lilady

    Kevin MD I agree with Orac above about permitting articles to be posted on your site, from “guests”. I think it is incumbent that you show some editorial discretion…unless you want to be a health resource in the style of the Huffington Post.

    Dr. Weiss has the chutzpah to compare complementary/alternative medicine modalities… for which there is no scientific research documenting its efficacy to Lunesta… which has scientific research documenting its efficacy with the specious argument “The mechanism of action of Lunesta is unknown.” As Dr. Weiss knows (or should know), many drugs, which have been used and researched for years and remain as first-line treatments for conditions such as epilepsy, work effectively and their “Mechanism of action is unknown”.

    The website: Epilepsy.com Professionals (Dilantin) provides you with that same statement under the header “Mechanism of Action”. Should people whose seizure condition is under control, seek “alternative” treatments to control their condition?

    Dr. Kevin, I think it is time for you to show some journalistic integrity.

    • Kevin

      Thanks for the comments. As mentioned several times in this thread, they will be considered when I choose future posts.

      Best,
      Kevin

  • LynneB

    The last thing people need is a formerly reliable source advocating gullibility as to how things work. Too many people already get scammed and they and their families pay the price in terms of both money and lost opportunities to treat real conditions with real and not sham expensive treatments.

    We do not need more exhortations to “keep an open mind” in a culture where on the one hand “Power Balance bracelets” are marketed by celebrities, and on the other far less benign hand there are large websites urging their readers to treat cancer by “altering their body’s pH.” We need critical thinking about physiology and plausibility and how we can know if something works.

    We do not need more squishy thinking about how “we don’t know how it works, therefore anything that works in an unknown fashion is equally plausible”, without going into how we know something works at all. We need to discuss the logic of science, and human psychology, and the fact that most conditions will clear up on their own, eventually, but people perceive and remember according to pre-existing inclination; THIS is what people don’t know and don’t learn from most of popular culture. Exhortations to magical thinking and “keep an open mind”, on the other hand, are everywhere already. The culture is supersaturated with them.

    We already have numerous channels of gullible TV reporting, and giant websites dedicated to feel-good faux medicine; we don’t need more.

    We need reliable and accurate and genuinely educated and clear-thinking sources, to stand up against the noise.

    And I don’t like the direction your posts have been going. “I just post them for discussion”, when there is no *embedded* discussion, no disclaimer, is a complete abdication of responsibility and just lets the nonsense wrap itself in supposed respectability from the more sane and well-reasoned posts; especially so since many people don’t read comments, just articles.

    Please don’t do this. If you want to discuss “alternate medicine”, then DISCUSS IT PROPERLY. Don’t hide behind “we don’t know how it works.” Be accurate about evidence. Don’t turn this into just another site that peddles feelgood bs.

    • Kevin

      Thanks for the comments. I agree with your criticism and they will be considered when I choose future posts.

      Best,
      Kevin

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