I’m looking at an advertisement for a “naturopathic and integrative” medical clinic that appeared in a local newspaper. The ad indicates they offer alternative medical options, complementary therapies, homeopathic and herbal medicines, medical second opinions, and hormone balancing. The clinic is run by a doctor of naturopathic medicine.[i] Now, depending on your point of view, these approaches are legitimate alternatives to Western medicine, or they are a complete sham and the doctor is not much above a shaman.
Alternative medicine is the broad term describing an array of treatments and therapies used in place of traditional, Western medical approaches. Complementary medicine refers to unconventional medical practices used in conjunction with traditional medicine. Examples of alternative and complementary medicines include acupuncture, aromatherapy, colon cleansing, high dose vitamin supplementation, homeopathy, magnetic therapy, Qi gong, reflexology, and spiritual healing. What these approaches have in common is that they have either failed to demonstrate clinically significant improvements or, as in the case of some complementary approaches, exhibit limited benefits for a few, specific conditions. Additionally, there is usually little or no evidence to explain how these approaches work, such as the biochemical mechanisms associated with traditional, Western medicine.
The key to understanding clinical effectiveness is understanding how treatments are tested. The most rigorous test is a double-blind study in which neither patients nor the practitioners know who is receiving the treatment and who is not. This is easier to do with new medications, as a fake drug can be manufactured that looks identical to the test medication, so no one knows who is getting the “real drug” and any change can be attributed to the medication and not some other factor. However, this kind of testing is more difficult to conduct with treatments, particularly when what you want to measure is based on the patient’s perception of change. For example, do individuals undergoing acupuncture really experience improvement or is it just a perception – a placebo effect? It’s a reasonable question to ask, because while some alternative and complementary approaches are benign, some may cause health problems, and worse, if a patient chooses an alternative over a traditional treatment, such as chemotherapy for cancer, they may put their very life at risk.[ii] And there is also the issue of cost. Many of these approaches have not been rigorously tested and the few that have been examined have not always demonstrated significant improvement. Consequently, most insurance companies do not cover alternative and complementary medicine and most users pay out-of-pocket for treatment.
Let’s look at two of these treatments to see why we should be cautious consumers and why a national health program would be reluctant to pay for them. Several years ago, I taught a graduate level course in research methods and one of my students wanted to do her dissertation on acupuncture. Acupuncture is based on the principle of Ch’i, a vital energy that, in Eastern philosophy, courses through our bodies. This life force flows through pathways and depending on where and how deep you insert an acupuncture needle, you can disrupt or redirect Ch’i and with it many maladies. There are different schools of acupuncture with different diagrams and places for inserting the needles. That’s what interested my student, because in Western medicine we treat what we observe and/or can measure, whereas with acupuncture, you cannot directly measure Ch’i and with disparate approaches you can’t be sure why it works.
Interest in acupuncture gained momentum in the U.S. in the 1970s after it was reported that the Chinese were conducting major surgery without the use of anesthetics. Although it was subsequently revealed the Chinese physicians had used sedative medications during the surgery as well as acupuncture, interest in the technique continued unabated. Because clinicians did not know how it worked, several studies were conducted demonstrating improvement for a number of conditions such as sinusitis, asthma, constipation, migraines, and back and joint pain. Clinicians still couldn’t explain why it worked, just that it appeared to work. One of the challenges scientists faced was that for many of these problems, improvement is based on self-report. If your shoulder aches, you might give it a 7 on a pain scale of one to ten. After acupuncture, you might report the pain is now down to 2. However, in both cases, the amount of pain you feel before and after treatment, the measurement is internal to you and thus subjective, unlike, say, blood pressure which can be measured by a sphygmomanometer. Thus, you may indeed feel relief, but is it due to psychological perception or to an actual physical change? So far, the results have not been very supportive. In a study using fake needles that convinced patients they were receiving acupuncture when they were not, recipients were as likely to report improvement as individuals in a control group who did not receive acupuncture for the same condition. In other words, the results were no better than placebo.[iii]
Now I’m sure there are some readers who’ve used acupuncture and fervently refute this conclusion; “what do you mean it’s all in my head?” That’s why it’s important not to trivialize the placebo effect. Most of us associate the term placebo with a false or sham effect; thus, it has a negative connotation. However, in recent years, medical scientists have been interested in what is often referred to as the ‘mind-body connection’, which is the affect our thoughts and feelings have on our health. Scientists have demonstrated through MRIs and other studies that our bodies do change in response to our thoughts and feelings. For example, hugging a person you love may increase release of endorphins, dopamine, and serotonin in the brain, and cognitive behavior therapies may help rewire neural networks to reduce anxiety and depression. So, while acupuncture may not reduce physical pain, i.e. the pain signals the nervous system is sending to the brain, the belief it does may indeed reduce our perception of pain. This explains why, although the studies have not demonstrated acupuncture works as claimed – that it blocks or redirects Ch’i – it may, nonetheless, be effective in treating some conditions, and this may be why some (not all) health plans currently pay for acupuncture treatment.
One other alternative approach is worth examining because unlike acupuncture, it is evident that is does not and cannot possibly work, and yet millions of dollars are spent each year for this useless treatment. Homeopathy is based on the belief that extremely small amounts of an ingredient can have the same effect as taking a large dose. This allows the homeopath to administer a chemical that might be toxic in a large dose but is believed to be therapeutic when reduced in potency. This is accomplished by placing the ingredient in water and continually diluting it until there may be only one part/molecule in a trillion left in the mixture. Under this circumstance, a mixture containing lethal heavy metals such as lead, mercury, or cadmium would occur at levels lower than found naturally in our food, water, or even in the air. In fact, when chemical analysis is done of homeopathic mixtures, they typically find the water has become so dilute the ingredient of interest cannot be detected at all. Like acupuncture, homeopathic cures may work due to the placebo effect, but unlike acupuncture, an individual may seek homeopathic treatment for a disease or illness that left untreated could worsen.[iv]
There are many other examples of alternative and complementary approaches to medicine. An entire market has developed in the past thirty years based on herbal supplements such as, Echinacea, evening primrose, ginkgo biloba, ginseng, and St. John’s Wort to treat ailments such as menstrual cramps, high cholesterol, low libido, and declining memory. So far, research has either debunked use of these herbs or demonstrated only a minimal effect. And because most supplements don’t come under the purview of the Food and Drug Administration they’re not reviewed for clinical effectiveness or safety, such as chemical impurities. Pharmaceutical companies have marketed the need to supplement your diet with vitamins, although a nutritionist will tell you that if you eat a balanced diet, vitamins are superfluous. And ionized water machines have not improved anyone’s health, other than the financial health of those selling the equipment. This is not to say all alternative medical approaches are bogus. However, like traditional Western medical approaches, they should be able to withstand critical analysis, and if the evidence does not support their efficacy, they should be withdrawn from the marketplace.
According to the National Institute of Health’s Center for Complementary and Integrative Health, Americans spend about $34 billion a year for alternative and complementary medicine. Fortunately, this is a very small proportion of the $3.3 trillion spent annually for health care.[v] Additionally, most of these therapies are not covered by health insurance, so they show up on the out-of-pocket expense side of the health care ledger. If we choose to spend our money on these products and therapies, it has more of an impact on our personal finances than on society’s cost for providing health care. The exception would be medical costs incurred if someone requires traditional medical treatment due to an adverse reaction to an alternative drug, or if their condition worsens because they eschewed traditional treatment.
People turn to alternative and complementary medicine for a
number of reasons. They may lack trust
in traditional approaches and/or be concerned that with traditional approaches
the cure may be worse than the illness (such as fatigue and nausea associated
with chemotherapy). For many it is a
desire to have more control over their personal health and illness and to take
a more active role in treatment. Some
may turn to alternative and complementary medicine to have more options when
receiving Western medical treatments. In
some cases, individuals are looking for cures for problems that have not been
resolved using traditional approaches.
This is often the case when individuals suffer from chronic joint and
back pain.[vi],[vii] Ultimately, American’s reliance on
alternative and complementary medicine should not be viewed as being good or
bad, rather it indicates the need to continue investing in medical research to
determine what works, what doesn’t, and how safe those treatments are.
[i] There are only eight schools of naturopathic medicine in the U.S. and Canada compared to 149 schools of allopathic and osteopathic medicine in the U.S. Currently, only seventeen states license naturopathic doctors compared to all fifty states for MDs and ODS. The AMA and other medical professional associations take a dim view of many of the claims made by alternative medicinal practitioners. For example, while medical research increasingly demonstrates a relationship between our health and the environment, nutrition, and exercise, that doesn’t necessarily support assertions by naturopathic practitioners. More information about naturopathic medicine can be found at www.naturopatic.org. More information about overstated claims of clinical effectiveness can be found at www.quackwatch.com
[ii] Radcliffe, Shawn (2018). Why Turning to Unconventional Cancer Treatment Increases Risk of Death. Healthline.com. August 1. https://www.healthline.com/health-news/why-turning-to-unconventional-cancer-treatment-increases-risk-of-death#1
[iii] Singh, Simon and Ernst, Edzard (2008). Trick or Treatment. W.W. Norton and Company, New York, N.Y.
[iv] Ibid. Singh and Ernst (2008).
[v] Americans Spent $33.9 Billion Out-of-Pocket on Complementary and Alternative Medicine. (2009). National Institutes of Health. July 30. https://nccih.nih.gov/news/2009/073009.htm [accessed 10/17/16].
[vi] Moore, J., et. al. (1985). Why Do People Seek Treatment by Alternative Medicine. British Medical Journal. Jan. 5, 290(6461), pp. 28-29.
[vii] Furnham, Adrian (2015). Why Choose Complementary and Alternative Medicine? Psychology Today. https://www.psychologytoday.com/blog/sideways-view/201504/why-choose-complementary-and-alternative-medicine