Some time ago, we published a systematic review aimed at identifying what patients might hope for when they consult a practitioner of alternative medicine. The most common expectations that emerged from this research are listed here:
- Less side-effects
- Symptom relief
- Cure of their disease
- Cope better with their condition
- Improve quality of life
- Boost immune system
- Prevention of illness
- Good therapeutic relationship with a clinician
- Holistic care
- Emotional support
- Control over their own health
In several ways, I think, these expectations are revealing; here I want to focus on one particular aspect, and ask the following question: To what extent are patients driven to see alternative practitioners simply because conventional medicine is letting them down? It seems to me that several items in the list above are an implicit criticism of mainstream medicine. This might get much clearer, if I re-phrase the points a bit: according to our findings, patients feel:
- that conventional treatments have too many side-effects;
- that they frequently fail to ease their symptoms;
- that they often do not cure the disease;
- that doctors do not enable their patients to cope with their condition;
- that doctors care not enough about their patients’ quality of life;
- that many conventional treatments neglect the importance of the immune system;
- that prevention is not given the importance it should have;
- that doctors are often no good at establishing good therapeutic relationships with their patients;
- that doctors fail to realise that their patients are not just “cases” but whole human individuals;
- that doctors are not providing enough emotional support;
- that doctors fail to empower their patients to be in control of their health.
Some of these points will probably strike a cord with most of us. I for one know of many instances where conventional physicians have failed their patients most miserably. All too often, the failings of modern medicine are as obvious as they are inexcusable! I can fully understand that disappointed patients look for help and compassion elsewhere, and I am quite sure that the failings of modern medicine are an important motivator for people to try alternative medicine.
But looking elsewhere might not be the best approach for improving health care. Alternative practitioners may well be more compassionate than conventional clinicians but features like empathy, time and attention can never make good medicine, if they are not accompanied by effective therapies.
The conclusion is therefore simple: whenever we encounter one of the many failings of conventional medicine, instead of turning away in disgust, we ought to make sure that mistakes are corrected, lessons are learnt and improvements are found and put into practice. Our aim must be to generate progress, and it cannot be reached by opting for unproven or dis-proven treatments.
25 Responses to Are the inadequacies of mainstream medicine to blame for the popularity of alternative medicine?
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I think you’re hitting the most important point here in the debate about alternative vs. mainstream medicine – and one that is far too often ignored.
Pretty much everyone agrees that the placebo effect is one of the main reasons why alternative medicine works. Now there’s an obvious conclusion to that: Embed the placebo effect – in an ethical (non-lying) way – into mainstream medicine. Not by giving placebo pills to patients (that’d be lying), but by taking enough time, caring for patients, making them feel good.
I personally had some very bad experiences with medicine in that regard in the past where I thought “What the hell is wrong here?” Where I had the impression that nobody cared how I feel with something. When doctors didn’t tell me what they were doing and were reacting annoyed when I asked.
Exposing quacks by explaining why their methods cannot work is right. But I’m deeply convinced: It’s not enough. And the single most important tool to fight quackery is to improve normal medicine.
There is also a broader social problem of us not being honest about how little we can do to help many health problems and the injustices they cause. While politicians like to speak of ‘equality of opportunity’, the fact remains that no matter how hard someone works, bad luck can lead to them facing serious disability and the arbitrary assessments of ATOS and the DWP. No wonder they will try anything to regain their health. I think that one reason that many people are dissatisfied with the efficacy of medical care available is that we have tried to promote too much confidence and trust in a medical system which is, in many ways, still groping around in the dark.
We’ve recently had Clare Gerada, Chair of the Royal College of General Practitioners, speaking out in favour of the use of placebos without informed consent, and against a legally enforced Duty of Candour. Often the interests of those with power do not coincide with the interests of patients. It is quite normal for patients to be mistreated within the NHS, and then find out how little this matters to anyone. They quite possibly would have been better off with homeopathy. It doesn’t surprise me that the Royal family are fans of homeopathy, considering the number of doctors that they will have had over the generations attempting to help them with potent treatments which do more harm than good. Remembering to ‘do no harm’ can get in the way of a desire to feel that one is doing some good.
We need to remember the importance of informed consent, and that even interventions like placebo or misplaced reassurance can be harmful if they affect patient behaviour. Until mainstream medicine adopts a more humble approach, with less faith and more accountability, and society becomes more honest about the common and life-limiting health problems which we cannot effectively treat but deserve support, people will go on being disappointed and looking for alternatives rather than face the difficult realities of life.
The problems and imperfections of medicine are a secondary cause. It is wrongly used as a rationale for anti-medicine. The propaganda of the alties unrestricted by any compulsion to provide correct information is the major factor. It is important to realise this as no improvement to medicine would make any difference, the lies would just continue. Education and proper information are the ways to combat this problem. Give everyone the tools to understand the deceptions.
I have lived with lupus for half my life, and during that time I’ve had some excellent and supportive doctors – GPs and especially my Rheumatologist. But in the early days before lupus was diagnosed I was constantly ill and with no explanation and little help for my symptoms. So I tried pretty much every alternative going – Chinese herbs, the more quacky nutritionists, homeopaths, herbalists, and Ayervedic doctor, and a hypnotist.
I think some of the things did help – I still take Omega 3 and Vitamin D, for instance. And the hypnotherapy helps with relaxation when in pain. But most of the help was probably just having someone who would listen and provide some kind of support. At the beginning I had a GP who treated me as if my symptoms were all in my mind. So that was an issue.
Then of course when one is finally diagnosed, there’s an expectation that there will be a good treatment, and for many conditions like mine there really isn’t.
It would help I think if there was more support for people in the position I was in twenty five years ago. To be simply told you have lupus, take these anti inflammatories, come back for another blood test in a year is really not enough. In the end I learned by myself through my own researches that the alternatives were mostly not helpful and some positively dangerous. But if I’d had better support from my doctor, then I wouldn’t have taken the risks I did. I now shudder to imagine what might have been the effect of those dradful smelling brews of chinese herbs that I took for so long – not to mention not even knowing what was in them.
So I think it’s a combination of things, in my case. I had high expectations of medicine, but one unluckily unhelpful GP and the lack of support with learning to manage and live with a chronic illness led me to make some very poor decisions, which I now regret.
I think it is the successes of medicine, and the resulting raised expectations, as much as its perceived inadequacies that make people want the sort of ‘miracle cures’ offered by CAM.
I do not know about the situation in the UK, but over here in Germany most of your points would boil down to the question of time the practitioner is able to spend on the patient. The way a practitioner is payed in Germany is a crazy thing about numbers of patients he treated last yeas and a sum of money per patient. This gives him his maximum budget, that he may earn by treating his patients. Mostly that would require him to pump about 1200 patients per three month period through his practice. If he fails to do so in one year his base in number of pateints will be smaller the next year, he will have a smaller budget the next year. If you assume an 8 hour working day spent on the public funded patients this roughly amounts to 20 minutes per patient – including all administration work inflicted on him to get his payment from the health agencies.
Maybe I am not just a little naive, but it is my firm belief, that any experienced praktitioner if only he would be able to spend more time on a single patient, this would allow him to listen to his patient and discuss things, improve his diagnosis and therapy by and by, as a homeopath can easily do. But here, a practitioner does not get payed for directly contacting his patient a second time in a yearly quarter if it concerns the same problem as before.
Cannot be an accidental coincidence that CAM was pretty much down in post war Germany and just started to increase again in the 1980s – just when the first cost restriction laws in public health service were issued.
Our aim must be to generate progress, and it cannot be reached by opting for unproven or dis-proven treatments.
If you’re sick, your aim is to get well, not to reform medicine.
And some unproven treatments can help, and eventually researchers will modify the unproven treatments into something that works better. But if you’re sick with something for which there is no good scientifically proven answer, you can’t just sit around being sick until researchers nail down the answer, and after the research is done, you can’t sit around waiting for medical doctors to incorporate the answers from research into their practice – which may take a long time.
The kind of “alternative” medicine that might help is the kind that is actually experimental medicine – for example, probiotics, food sensitivities that don’t show up on allergy tests, etc. It’s based on clinical experience, and it may be tentatively supported by medical research – for example, studies on animals that suggest there’s something to the idea – but it’s not definitely proven, so it’s not mainstream medicine.
A lot of medical doctors look at alternative medicine and try to pick out what may work. They don’t do this very well, I think. A lot of the “alternative” things I’ve heard MD’s mention seem like the doctor has surfed online a bit without really looking to see if the ideas have at least some support in medical research.
Perhaps there could be some systematic way of evaluating this kind of experimental “alternative” medicine, so that individual MD’s don’t have to guess on their own.
And, when trying experimental medicine, a self-protective attitude is very important – not to do anything that seems likely to be harmful.
…but for picking out what works, they need evidence; and if there is evidence for a therapy, it is no longer unproven.
There can be some evidence, as I said – like studies in animals that are suggestive – but not enough evidence to consider the treatment proven effective. In that case it may make sense to experiment – but many MD’s will not do that. People with such problems are left unhelped by mainstream medicine.
could this be because EXPERIMENTING ON PATIENTS OUTSIDE CLINICAL TRIALS IS UNETHICAL?
Well, if you consider it unethical, then people with problems where there isn’t a well-established mainstream treatment will not be helped by mainstream medicine.
Then those people will experiment on themselves. They have problems, they need to do something about them.
But their experiments on themselves, will usually NOT be based on the knowledge of physiology and what is reasonable, that MD’s do have.
This is not about the failings of mainstream medicine. It’s about the failings of mainstream healthcare systems. In particular the under resourcing of NHS primary care such that patients get disease focussed 10 minute appointments. And the perverse incentives to NHS GPs to count beans and tick boxes to comply with the agenda of politicians rather focus on the patient’s agenda. The GP gets £60 per year to provide for the healthcare needs of the average patient. That’s per year not per consultation or per episode. What patients don’t get is time because time costs. If general practice was resourced to provide the length of consultation that patients pay alternative practitioners to get the situation would be very different.
yes, i agree – at least partly. we should, however, consider that we are patly responsible for the system. it would be a bit too easy to say “this is entirely the politicians’ doing” i think.
If only that we’re true. Workload in GP is at saturation point. There is no capacity for new work. The BMA GP negotiators failed to persuade HMG of that and more work is being imposed with reduced funding next year. The 2004 nGMS contract allows HMG to unilaterally impose changes with 12 weeks notice.
There will be real cuts in services and patient care. Staff will be made redundant. Patients will suffer. Politicians will blame GPs. I will take a pay cut for the 9th year in a row. I now take home less than I did in 2002 for at least 25% more work. Those who can retire will. Others will emigrate or collapse under the strain. And Richard Branson will take over the ruins of primary care with international medical graduates at Tesco shelf stacker wages.
Also there may be clinical experience suggesting that a treatment works.
There isn’t a Great Divide separating mainstream and alternative medicine – there’s a gray area in between, of treatments that are plausible, supported by clinical experience or tentative evidence from research.
It’s in that gray area that MD’s often let people down.
For example, hypoallergenic elimination diets followed by food challenges are often not suggested by mainstream doctors – but this is a very plausible empirical way to investigate whether problems are food-related.
The researcher Lidy Pelsser recently found that a lot of children with ADHD were food-sensitive, by using elimination diets followed by food challenges. So, treating ADHD by excluding specific foods has recently received some support from research.
However, parents have had children with ADHD for many years, and for many years people reported such psychological symptoms resulting from food sensitivities, and sometimes they determined this with a hypoallergenic elimination diet and food challenges. Those parents who used such an empirical approach might have helped their children, reducing the use of drugs, when other parents who simply went to the doctor, used a lot of drugs on their children without addressing the basic cause.
And even now that there is evidence that a lot of ADHD is food-related, it may not be enough for some mainstream MD’s to recommend trying food elimination. Or they may not be keeping up with the research.
I do wish that MD’s were better at looking at plausible empirical treatments. The alternative practitioners often peddle a lot of treatments that are not plausible – but at least they do pay attention to clinical experience and (sometimes) tentative evidence from research.
are you sure? i fear that most alt med practitioners cherry pick research data that supports their assumptions. conventional doctors have to be more cautious and tend to accept new evidence only once it is solid. however, it is problematic to generalise accross professions.
The flaws in the Pelsser study are that there was a lack of blinding and lack of objective measurement of ADHD symptoms. It was based on the opinion of parents and teachers who knew the child was enrolled in the study rather than using a validated tool for objective assessment of symptoms.
Lidy Pelsser’s paper is at http://www.adhdenvoeding.nl/cms/wp-content/uploads/2011/02/Pelsser-The-Lancet-2011-Publication-INCA-study.pdf
According to the paper, there was a double-blind crossover phase.
I’m not arguing for seeing an alt-med person. Yes, there are lots of biases, and for anything, including homeopathic remedies that can’t have an effect beyond placebo, there are people who will swear it works.
As for picking out what seems reasonable – MD’s have physiological knowledge that helps them do this.
For example, people have often reported problems with a particular food additive – or said that organic foods are OK, there’s something about the preservatives on “conventional” foods that causes problems. I’ve always been skeptical about those reports because a) the additives and preservatives are there in very small amounts, b) immune reactions are usually to proteins, and additive and preservatives aren’t proteins (so far as I know), and c) I know that people have a tendency to be phobic about “chemicals”, so there’s a reason to believe they might be wrongly blaming additives and preservatives.
This seems to be (somewhat) borne out by research, Lidy Pelsser found foods, individual species used for food, were contributing to ADHD, NOT additives and preservatives. And many people blame aspartame, which is a little peptide that would be unlikely to cause an immune reaction, for a lot of problems. Yet I’ve heard that when people think they have a problem with aspartame, it’s something else – like, if someone habitually munches peanuts along with the aspartame sweetened coffee, and they actually have a peanut allergy.
I’m saying I wish MD’s did a better job of integrative medicine. I’ve gotten what seems to me to be un-plausible and sometimes likely harmful advice from integrative MD’s, and MD’s in general haven’t informed me of some plausible and reasonable things to try.
Luara said:
First, show that it is medicine.
But as I said the Pelsser study had substantial methodological flaws so you can’t draw that conclusion. Most of the research showing positive effects of alternative medicine are either methodologically flawed with significant bias and confounding or there are conflicts of interest that cast doubt on the validity. I haven’t seen a well designed methodologically robust study that supports alternative medicine yet.
conventional doctors have to be more cautious and tend to accept new evidence only once it is solid.
Mainstream doctors are very cautious partly because of a fear of malpractice suits. I’m afraid fear of lawsuits and the cost of malpractice insurance looms very large in their decision-making. Perhaps that gets in the way of the kind of empirical but reasonable medicine I wish they would do.
So what you’re saying is mainstream doctors practice evidence based medicine and don’t practice medicine not proven to be safe and effective. And you’re saying that’s a bad thing?
“Yet I’ve heard that when people think they have a problem with aspartame, it’s something else – like, if someone habitually munches peanuts along with the aspartame sweetened coffee, and they actually have a peanut allergy.” Gracious God, anyone who habitually ate peanuts with sweetened coffee should be in intensive (taste) care for starters!