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.