If you read this article carefully it seems that he says that we must never
let common sense or thousands of years of history and tradition influence
our thinking. This presents the very reason that
more and more people regard the medical establishment as narrow minded and
not trustworthy.
by Steven Novella, MD
The Connecticut Skeptic Vol.1 Issue 1 (Winter '96)
There is a growing phenomenon in this country which is very diverse and
yet can be grouped collectively under a single name: alternative medicine.
What this term basically represents is any health care which is not part of
the mainstream medical establishment, and it includes all such therapies
from chiropractic to crystal healing. Despite the tremendous disparity in
philosophy, organization, practice, and origins of the myriad types of
alternative medicine , the growing acceptance and use of these therapies is
part of a single cultural phenomenon. It is also an extremely dangerous and
costly one.
First let me address what the critical difference between mainstream
medicine and alternative medicine truely is, and why the latter is cause for
concern. In short, mainstream medicine is a scientific endeavor, and
alternative medicine is not.
Medical practice was not always steeped in the traditions of science.
Two centuries ago the discipline of medicine was based on dogma and
authority, research was sporadic and uncoordinated and was not generally
accepted as the way to improve the practice of medicine. Slowly, however, a
few gifted scientists began to show how research and experimentation, in the
modern sense of the terms, can yield real knowledge which can be used to
treat and cure patients. One by one, diseases began to fall under the
understanding and control of physicians, and the results were undeniable.
Today, medical research is a multi-billion dollar industry. Every
physician is exposed to basic science and clinical research to some degree
during their training and the links between the science of medicine and the
practice of medicine are strong. Physicians in training learn early on that
authority means little, if one does not have the facts to back up what one
is saying. It is common for medical students, the lowest members of the
academic medicine hierarchy, to politely ask their attendings for the
article which demonstrates their assertion. I have never met an attending
to be offended by or to refuse such a request, because such behavior would
expose them as dogmatic and not scientific, destroying their reputation in
academic circles.
Physicians also learn through clinical experience to be highly skeptical
of just such experience. That is, simply because a treatment seems to be
effective by casual observation is not enough to conclude that it is. Time
and time again, with stunning regularity, our own naive assumptions and
observations are invalidated by careful scientific research. We learn to
question everything we think we know, to base our clinical practice on solid
research, and not to be swayed by so-called anecdotal experience. One
cannot be a competent physician today without subscribing to an array of
medical journals in order to keep up with the latest research.
Why is anecdotal experience so fallible? In part it is because human
biology is extremely complex and variable. Physicians are fond of saying
that no two patients are exactly alike, and therefore the results of our
interventions are never completely predictable. Also, we rely heavily on
the patient's subjective experience of their own disease and symptoms. I
can only know how much pain a patient is experiencing by what they tell me;
there is no objective measure. Patient's expectations, the so-called
placebo effect, are very powerful and greatly affects their beliefs about
whether or not they are getting better or worse. Physician expectation is
also a factor, for if we believe a patient should be getting better, our
assessment of them may be biased in that direction.
Another feature of modern medicine that is important to understanding
the alternative medicine phenomenon is that it is greatly imperfect.
Medical knowledge is vast, but medical ignorance is even more vast. Many
illnesses still have no cure or only imperfect cures. Physicians are often
reduced to managing symptoms, which is important and improves a patient's
quality of life, but does not offer hope of altering the disease course
itself. Many diseases are not understood or only poorly understood, and
even proper diagnosis is often a challenge. Another reality medical
students learn early in their training is the limitations of their own
knowledge and power.
Medical practice today is also highly technological. This is one of its
strengths, but it is also a potential weakness. Patients often perceive
their experience with mainstream medicine as being impersonal and uncaring.
They are often put through a scary battery of tests and examinations which
they have little chance of understanding. It is easy for patients to become
overwhelmed by the complexity of the delivery of modern medicine and the
technology of its practice, all at a time when they are especially
vulnerable because they are sick.
Enter alternative medicine.
It is easy to understand why people would be drawn to the allure of
alternative medicine. Those therapies that are most successful are often
very good at the personal "warm and fuzzy" aspect of heath care. They also
make very straightforward claims with regard to diagnosis and treatment.
What patient does not want to hear "this is what your problem is, and here
is the cure?" There is rarely any gray zone or uncertainty. Also, the
interventions tend to be very hands-on and often even pleasurable, such as
massage therapy or therapeutic touch, very different from the needles,
probes, and x-rays of mainstream medicine.
What is the problem, then? It sounds like mainstream medicine can learn
a great deal from alternative medicine, rather than the other way around.
The problem is that many, if not all, forms of alternative medicine make
claims which are not based on firm scientific research. Some, such as
crystal healing, healing touch, and Rei-so (spiritual diagnosis), are based
on the concept that physical health depends upon spiritual health or having
the proper balance and flow of life energies.
Others, such as aromatherapy, homeopathy, and herbalism, cite
physiologic mechanisms for their actions. Still others, such as the
Laetrile society, claim that the treatment they have to offer is the product
of scientific research but that a corrupt medical organization is conspiring
to keep this genuine therapy from patients.
Often, proponents of any particular form of alternative medicine can
recite long and complex explanations for the basis of their therapy. They
can often claim that the knowledge they use is thousands of years old, or is
widely used in other cultures but neglected in western European culture.
They all will make bold statements about the power of their therapy and even
be able to provide stunning testimonials to support their claims. What none
of them can produce, however, is solid, reproducible scientific research to
back up their claims.
It is this fact alone which distinguishes alternative from mainstream
medicine. If any therapy, no matter how unorthodox, were grounded in
research, and could be repeatedly shown to be safe and effective, then it
eventually would be incorporated into mainstream medicine. Novelty will
always meet with initial resistance, but the history of medicine, and indeed
science in general, has repeatedly shown that the facts in the end reign
supreme.
Defenders and practitioners of alternative medicine claim that their
therapies are natural and holistic, whereas mainstream medicine is
artificial, invasive, and treats patients as diseases. They will often say
that physicians are as dogmatic as their predecessors of previous centuries
and that their attacks against alternative medicine are based solely on
their desire to protect their own monopoly on health care. These verbal
attacks by adherents of alternative medicine against their perceived enemies
are a simple distraction from the real question - why should a skeptical
individual believe that there is any credibility to the diagnostic and
therapeutic claims of a particular form of alternative medicine? In short,
medical scientists state that a particular therapy has no scientific basis,
and the practitioners of that therapy reply, not with evidence or research,
but with cries of dogma and protectionism.
On closer examination, the criticisms of mainstream medicine listed
above are largely empty. The terms "natural" and "holistic" have been so
broadly applied as to become virtually meaningless. The trend in medical
education towards a more complete view of the patient (the so-called
biopsychosocial model) is largely ignored. Making comparisons between
modern medicine and the beliefs of previous centuries serves only to reveal
extreme ignorance about the fundamental revolution in science and medicine
that has occurred in our society. And claiming that physicians speak out
against alternative medicine only to protect their monopoly belies a
complete misunderstanding of the organization of academic medicine as
distinct from private practice. In the end the attacks of alternative
medicine practitioners are revealed for what they truly are, preemptive
strikes against the one segment of society that can reveal the emptiness of
their claims - the medical community.
This, of course, is not to suggest that mainstream medicine is beyond
criticism; it is not. Nor am I implying that all forms of alternative
medicine are without value, but they lack a mechanism of systematically
testing their value.
The FDA was established to protect the public from so-called snake oil
salesman, slick con-artists who sold useless or even harmful concoctions
with a long list of unsubstantiated health claims. Before a physician can
prescribe a drug to a patient, that drug must be proven, through many years
of stringent research, to be safe and effective for specific indications.
The medical community, through licensure, hospital privileges, referrals,
and peer review regulates the activities of all physicians so that a certain
standard of care is maintained. Alternative medicine operates completely
outside of this system. They can make claims without the burden of
scientific proof and prescribe therapies without any precautions for their
safety.