“Maybe it is as simple as: I enjoyed that treatment, it was worth the amount I spent on it and I feel better.”
This argument between the fans and the critics of so-called alternative medicine (SCAM) might be the key to understanding the two opposing positions. It applies across the board to all the SCAMs that lack solid evidence (which, of course, is most).
- The sceptic asks for evidence of effectiveness and finds none that is convincing. He concludes that the SCAM is not evidence-based.
- The SCAM enthusiast cannot argue with the evident lack of evidence, but says (as Angela did in a recent comment): “Maybe it is as simple as: I enjoyed that treatment, it was worth the amount I spent on it and I feel better.”
Both positions may well be correct. And both are held with total conviction. Thus, many consumers who are not deeply into SCAM are confused or even bewildered.
So, how can we make sense of this situation?
Let me start with the argument of the SCAM enthusiast. She is, of course, right to sate that she enjoyed reflexology, or aromatherapy, or crystal therapy. She might also enjoy having her hair done, or soaking in a bath, or drinking a glass of champagne. There is nothing wrong with that, and we should all be happy for her.
Enjoying something is often good for you – often but not always. Enjoying a fag isn’t. Enjoying a bottle of whiskey per evening isn’t. Enjoying a drive at neck-breaking speed on a public motorway isn’t. Enjoying sending out hate-mail isn’t. But innocent treats like a foot massage by an aromatherapist probably is!
But none of these things can be considered to be a THERAPY. Feeling better is not necessarily a therapeutic aim.
So, the situation might not be so confusing after all: enjoyments are enjoyments. They are usually fine, and they are often very personal. Some people enjoy being massaged, others don’t. But enjoyments are not therapies. This means that all would be fine, if we stopped calling aromatherapy, reflexology, crystal therapy THERAPIES, and if we stopped calling aromatherapists, etc. THERAPISTS.
Therapies are medical interventions, and as such they need evidence to back them up, evidence that they do something positive to our health. Therapists are healthcare professionals who make therapeutic claims that need evidence to back them up. If that is missing, sceptics are entirely correct to criticise them. In fact, they fulfil a public service when criticising bogus therapies or claims.
So, the confusion mentioned above mainly arises from mislabelling enjoyments as therapies. Lets call aromatherapists, etc. by different names, and the confusion disappears. Let’s stop aromatherapists, etc. making therapeutic claims, and there is no more reason for sceptics to criticise.
40 Responses to I enjoyed that treatment, it was worth the amount I spent on it and I feel better
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Perhaps instead of focusing on the first part of the statement (enjoyment), this argument would hold more value if we focused on the last part (feeling better).
Meanwhile, the choice of the acronym SCAM for “so called alternatively medicine” is quite witty but also biased and derogatory which makes it harder to respect intellectually.
Perhaps a little intellectual honesty and a look in the rear view mirror of medical history would enlighten us…
All therapies, including surgery, radiotherapy, the use of chemicals (whether extracted from herbs or synthetized) were once considered “alternative” or “revolutionary” or “witchcraft”… or a scam!
Some were, indeed, scams.
Some proved rather effective and eventually earned their place in the schools and universities of medicine around the world.
While I respect and value the debunking of charlatans whose main interest is to profit from people’s gullibility, I also respect experts who keep an open and curious mind.
Perhaps a honest scientist could admit that there is much he doesn’t know yet, and that alternative thinking is how medicine progresses?
Until a therapy is proven ineffective, it suggest it may be worth looking into… especially if many people claim to feel better after receiving a treatment.
“Until a therapy is proven ineffective, it suggest it may be worth looking into… especially if many people claim to feel better after receiving a treatment.”
I have been doing this since ~25 years and published more than anyone on the planet about it in the peer-reviewed literature.
https://edzardernst.com/2019/08/blowing-my-own-trumpet-to-the-tune-of-a-standardized-citation-metrics-author-database-annotated-for-scientific-field/
so no need to lecture me.
but you should know that “Until a therapy is proven ineffective…” makes little sense.
1) it is hardly possible to prove a therapy to be ineffective [it’s not how science works].
2) responsible healthcare focusses on those therapies that are proven to be effective [this is how science works].
Hi Edzard
Rest assured that I do have respect for what you are trying to do. Charlatans and snake oil salesmen need to be debunked, and you are doing the world a favor by exposing bad practices.
However, I believe that you misunderstood my comments.
Firstly, I am not qualified to lecture anyone here and I apologize if my previous comments upset you. I am just a guy trying to learn something on your blog and sharing his opinion, sometimes adding elements of information to illustrate my point.
Secondly, while I totally agree with your second point (focusing on therapies that are proven to be effective), I find that you often extrapolate in an attempt to achieve what you agree is “near impossible” in your first point (proving a therapy to be ineffective).
I assume that this is motivated by your desire to reinforce your hypothesis (all ACM are rubbish and should be rebranded SCAM), in the absence of conclusive elements to support this hypothesis.
This is probably not how science work either.
rest assured you did not upset me.
rest assured I do not think that all SCAM is useless [https://www.ncbi.nlm.nih.gov/pubmed/18318982]
As luck would have it, Orac’s blog post of today addresses this very point.
No. Alternative thinking is almost exclusively the product of human imagination, and often comes up with the craziest ideas, without any structured approach or regard for plausibility (or even basic natural laws). And those who come up with these ideas will subsequently stick to these ideas no matter what, even when confronted by huge amounts of evidence that they are wrong. This is even far worse with those whose livelihood depends on the alternative treatments they sell. It is very, very rare for e.g. a homeopath to realize that he or she is wrong, and that the idea of creating medicines by simple shaking and diluting of water is of course very silly.
The wild variety and huge numbers of alternative treatments that people come up with already make it impossible to test all these for medical effectiveness — and proving that they are not effective is far more difficult still.
The fallacious alternative mindset is perhaps best demonstrated by the simple fact that almost all alternative treatments(*) appear more or less equally successful — which of course is very strange. In real medicine, doctors are already happy if there is just one reasonably effective treatment for a condition. In reality, almost all alternative treatments are placebo treatments, and their ‘success’ mostly relies on the fact that the vast majority of conditions eventually resolve on their own.
Medicine nowadays progresses mostly by researching and documenting the myriad of processes happening in living creatures, and trying to find what causes one or more of these processes to go wrong. And oh, pharmaceutical companies also work the other way, routinely testing lots of substances to see what they do. Also, technological developments enable progress in surgical procedures and radiology. The third way we make progress has to do with disease prevention and lifestyle.
But ‘alternative thinking’ is nowhere to be found in all this. Even when looking at the past century, I can’t think of any previously alternative treatment that has become part of regular medicine, apart from maybe a handful of herbal substances. And this is most certainly not for a lack of alternative treatments to choose from … But perhaps you can give examples of alternative treatments that have recently become part of mainstream medicine?
*: This Wikipedia page lists already some 200 treatments. And Prof. Ernst’s latest book lists at least a dozen more that aren’t mentioned here (e.g. slapping therapy). Should they all be taken seriously or at least treated respectfully “because we don’t know everything”? Should they all be carefully investigated? And why are there lots of treatments still on this list that for all intents and purposes have been proven useless?
https://edzardernst.com/2018/08/random-thoughts-on-the-issue-of-an-open-mind/
In my experience, alternative believers certainly do not have an open mind for the notion that they may be wrong.
this is also my impression; however, I have also seen some (not many) sceptics who are totally closed to SCAM, even if supported by some good evidence.
But if SCAM is supported by good evidence, it stops being alternative.
yes, in theory.
in practice, it can take a while.
@Lenny
I’m racking my brain trying to come up with an example of this happening, but apart from a few herbal treatments (and I really mean ‘a few’), I can’t think of anything. Oh, wait, blood-letting is an effective treatment for haemochromatosis – but that doesn’t really count, as blood-letting was historically used for countless conditions, so its proven therapeutic value for just this one condition is more of a coincidence than an actual piece of old medical wisdom that turned out to be true.
Can anyone come up with any examples of actual alternative treatments that made it into regular medicine?
If not, then the most sensible approach is to reject alternative treatments by default, and only spend effort on further research in those extremely rare cases that there is plausibility AND at least some credible evidence of efficacy. (And even then, results will no doubt be overwhelmingly negative.)
Support blood letting, give donations regularly.
@RichardR
It’s a good point. It would probably be more accurate to say that IF a SCAM was supported by good evidence, etc
Was cognitive behavioural therapy ever considered alternative? That’s now very much mainstream.
Hi Richard, thank you for taking the time to respond and comment.
I agree with most of the points you brought up (particularly with disease prevention and lifestyle) but perhaps you misunderstood what I describe as “alternative thinking”.
When Galileo suggested that the earth was not flat, wasn’t his thinking “alternative”?
When mainstream medicine recommended the use of bloodletting in order to “let bad humours escape” (apparently we can thank Hippocrates for that enduring concept), were “alternative thinkers” not right by suggesting that, perhaps, there were better ways to treat patients?
When what I consider to be pioneers of modern surgery (yesterday’s “alternative thinkers”) had to steal bodies and hide to dissect them at night in an attempt to understand our anatomy, they were at grave risk because the medical establishment at the time believed such practices to be against God’s will and could be branded “witchcraft” (SCAM had not yet been coined by Edzard).
All I am saying is, yes, please, do expose the rubbish and dangerous practices, but be careful not to get rid of the baby along with the dirty bath water.
What can be described as “regular” or “mainstream” medicine is nothing more than a photograph taken at a certain point in time describing what we collectively agree to be beneficial to our health. Personally, I find that reducing all ACM to dangerous fallacy with the exception of a handful of herbal substances is a bit caricatural.
Many remedies found in pharmacy are little more than “mother nature” getting branded, either by extraction or synthesis, so I believe that we owe a bit more respect to this “handful of herbal substances”.
It is a fact that our immune system does a great job, and if we only looked after it a bit better we would probably need to “consume” a lot less medical products and services.
We probably all could be a bit more humble about medicine in general (“alternative” or not) when so many drugs/remedies aim at reducing unpleasant symptoms rather than curing diseases. Our immune system does that curing job for the most part. Meanwhile, misdiagnosis and malpractice can kill but they are not exclusive to alternative medicine, unfortunately.
I will do my best to answer your question by providing examples of alternative treatments becoming mainstream medicine recently, all depends on your definition of “recent” and also in which country/culture.
To remain safe, I could include every single treatment that is today part of mainstream medicine since the beginning of recorded history of medicine, worldwide.
Ok, I am being a bit of a smartass right there, so I will answer your question more precisely on alternative treatments that “made it” in mainstream medicine in the past 25 years in Europe and the US.
fasting
meditation
osteopathy (used in hospitals in the UK and USA )
reiki (used in hospitals in France and USA)
Here is an old but interesting article on osteopathy : https://www.nytimes.com/1998/02/17/science/scorned-no-more-osteopathy-is-on-the-rise.html
To conclude, I would totally agree with your statement that it is dangerous to “stick to ideas no matter what, especially when those come from people whose livelihood depends on the treatments they sell”. But this, also, is not exclusive to “alternative” treatments and even “mainstream” experts can be found guilty of this crime.
So… Alternative Cosmology? That’s not a thing. In fact, where are the Alternative Chemists? Or Alternative physicists? How about Alternative Mathematics? There’s a reason Alternatives to Medicine don’t get taken seriously.
Also, Galileo didn’t suggest the Earth was not flat. That was well known at that point. One of the things he’s known for was the proposition of heliocentrism.
To answer the question though, no. The conclusion he reached was based on the best evidence of the day. Due to when this happened in history he was the one producing that best evidence. As I understand it his peers at the time were impressed with the work and it was the church, not his peers, that took umbrage with his findings.
Gold
Gold said;
“There’s a reason Alternatives to Medicine don’t get taken seriously”
Alternatives to Medicine don’t get taken seriously …. by who ?
Those that seek alternative treatments, are very sincere about treatments sought out by those with broken health. They look for healthy solutions that EVM has not been able to provide for them.
Can you blame them is EBM has failed ? I know, I’ve been there and done that.
Let them have their placebo… if nothing else.
Fair. I should have been clearer. Although I would have thought the preamble to that statement would have been enough.
So, to rephrase; There is a reason alternatives to actual medicine don’t get taken seriously by the wider medical and scientific communities.
Mr Monnier,
You seem as misinformed about the history of medicine as you are of nearly every other subject on which you have given us your opinions.
Galileo did not suggest that the earth was not flat. The ancient Greeks showed that it was a sphere and made a reasonably accurate attempt at measuring its circumference.
Although universities have been conferring medical degrees for centuries, there was no mainstream medical system as such until comparatively recently. There were a great many different approaches, some of them based on Galen’s concept of imbalance between body fluids and some of them not. Doctors and other healers did as much harm as good, or possibly more, despite which they were held in very high regard (though not necessarily by each other). What changed, about 200 years ago, was the idea that treatment should be based on evidence rather than tradition. For the first time treatment could do more good than harm and it is from this that modern medicine emerged. What we now regard as “alternative” are treatment systems based on tradition, dogma and magical thinking, rather than on evidence.
What you consider to be the pioneers of modern surgery were nothing of the sort. Anatomists aimed to understand the workings of the human body from its structure, but they were very careful to distance themselves from anybody who might be regarded as a surgeon. The true pioneers of surgery were originally barbers and blacksmiths, who would step in to set a broken bone or amputate a limb but were not in any way medically qualified. This distinction lives on in Britain where surgeons drop the title “doctor” once they attain Fellowship of the Royal College of Surgeons and go back to being Mr again.
It was not the medical establishment who were against dissecting cadavers – indeed they were the only ones doing it. However, it was widely believed that resurrection of the body after death could only occur if the body remained intact. For this reason, serious crimes (such as treason), where execution was not considered to be sufficient, were punished by quartering – the body would be cut into four pieces after death and each piece would be taken to a different city for display and eventually separate disposal.
It is not surprising that evolution should have equipped many plants and animals with the ability to synthesise pharmacologically active substances to give them an advantage in the struggle for survival, and many of these have proved useful sources of, or at least starting points for, modern drugs. However, there is a lot more to drug development than branding. For that matter many drugs are designed by chemists after the identification of specific molecular targets and biological pathways and have nothing to do with anything found in nature.
What do you mean by that? Anybody with a basic training in pharmacology is well aware of the origin of particular groups of drugs. Doctors prescribing drugs judge them on the basis of how useful they are, not on their origin.
Nobody with any knowledge of medicine would deny the fundamental role of the immune system in enabling the body to function at all given the constant onslaught of bacteria, viruses, fungi and parasites. It is an immensely complex system and if any part of it is compromised then the consequences can be severe. However, I have no idea what you mean by “looking after it better” or how you think we should go about that.
What about trauma (by which I mean injuries, not anything psychiatric)? Vascular disease (strokes and heart attacks)? Metabolic disease (diabetes etc.)? Cancer? Degenerative disease (all the problems associated with aging)? What about where the immune system is actually responsible for the disease (rheumatoid arthritis, SLE, type I diabetes, asthma)?
I think you will find that mainstream medical practitioners are well aware of the limits of what they can do, though I am not sure that this is the case for alternative therapists.
It is certainly not true that medical management is mostly aimed at reducing symptoms. Much of it is preventative, and the rest is largely aimed at the cause of the problem not the symptoms resulting from it. There are many chronic conditions for which there is no cure (diabetes, cardiovascular disease, metastatic cancers) but appropriate treatment enables these to be controlled and allows people to get on with their lives. It is certainly not just symptom control.
Though when it comes to symptom control, don’t be so dismissive of the specialty of palliative medicine.
That is certainly true, though one difference between mainstream and alternative medicine is the willingness to examine where things have gone wrong and to change practice accordingly.
Just because something is used in a hospital somewhere doesn’t mean that it is part of mainstream medicine. I don’t think any of the examples you mention are available in the UK through NHS hospitals. Private hospitals, on the other hand, will endorse anything profitable that they can get away with.
You have stated elsewhere that you approached this blog with a view to seeing what you could learn from it. I would venture to suggest that the most important lesson to take away is that if you persist in holding strong opinions on matters in which you are largely ignorant, and continue to dispute established facts, then this will hamper your efforts to learn anything new.
If SCAM treatments marketed themselves as placebos it is unlikely many of us here would have an issue with them. But they don’t, and that is the problem. They make promises that can’t be delivered by a placebo. They prey on the vulnerable, ignorant and miseducated.
LET THEM EAT CAKE
that too did not age too well, did it?
Gold
Gold said;
“If SCAM treatments marketed themselves as placebos it is unlikely many of us here would have an issue with them. But they don’t, and that is the problem.”
Withing
With EBM, a certain percentage of success is placebo effect also. I’ve never heard an MD tell me or anyone I know, that any success derived from the MD prescribed treatment might be attributed to placebo effect. Why are they not also marketing their treatments as such ? hmmmm
Here is the difference. With CAM and homeopathy treatments patients have already chosen for themselves not to seek out MD’s… for whatever reasons… I have my reasons. So in many cases EBM has already been taken off the table as an option. Some people just don’t want CHEMO… right ?
Many patients are looking for a treatment that “does no harm” as the cliche goes.
CAM and homeopathy treatments give the person an option to allow something else other than EBM to take its course.
One more remarkable thing about placebo effect. Patients are capable of receiving an equal placebo effect even if they know they are receiving a placebo…. how great is that ?
” Feeling better is not necessarily a therapeutic aim.”
Classic.
The problem with SCAM as I see it is that usually the practicitioners adopt medical terminology becasue otherwise they would not get the public engaged. This is the deceit and why they should be exposed and held to account. Chriros call people who come to see them ‘patients’ and the appointment system they run is referred to as a ‘surgery’. Why if not to try to align themselves with real medical practitioners? Reflexologists ‘diagnose’ conditions that they find while massaging the feet. Acupunturists take a medical history before applying any needles. They all stray into the medical world precisely because they know this gives what they do an air of validity.
People will always prioritise their health. They are more likely to spend money on something purporting to be medically beneficial. If they had to prioritise between a health benefit and having a nice massage they would prioritise the former. If SCAM practitioners are so confident that what they do belongs works why do they need the subterfuge?
Reference ‘alexandre monnier’ comments, I agree with you! There are too many neat & tidy labels given to others by Mr Ernst. ‘Alternative Medicine’ is just one silly example! Where do you place the ‘red line’ dividing conventional medical treatment from everything else? I think you know Mr Ernst that medical Doctors routinely prescribe placebo pills to certain patients – and they have been shown to cause positive physiological changes and improvements in many of these ‘placebo’ patients. Would you say that placebo pills should never be prescribed under any circumstances. Your obsession with promoting ONLY so called medical interventions (SCMI) while everything else is bogus makes you look rather foolish (nothing personal, I’m sure you are a very nice chap really!)
thank you; I love you too
Placebo effect is a medical conundrum. In fact, placebo effect is not the friend of medical science.
Only to those who do not understand it.
And to many people that promote it do not understand it. :/
Ha! 🙂
Oh? That was a serious question? Really?
The red line may be fuzzy, but there are things that can definitely be put on one side or the other.
I somewhat agree with the take on ‘Alternative Medicine’ too. To be fair though, writing out Alternatives to Actual Medicine all the time becomes tiresome and really shouldn’t need to be said.
But, to your point. That red line. On one side we have alternatives to actual medicine and on the other we have actual medicine. The way these are determined is typically through research and the aggregation (we want lots) and filtering (we want the best quality) of that research to establish a consensus. This tells us with a reasonable amount of certainty if a claimed effect is real or not.
I find it odd that this needed to be explained.
@ Mike Grant on Monday 11 November 2019 at 15:11
Firstly, let’s clear this up; you are not a doctor, you are a half-arsed chiro. https://www.completetherapynj.com/
What’s more, you are a subluxationist which has been discredited so many times, it doesn’t need any more.
To quote:
“What truly differentiates doctors of chiropractic from any other healthcare professionals is the fact that chiropractors are the only professionals who are trained to diagnose and treat what are called spinal subluxations. The word “subluxation” comes from the Latin words meaning “somewhat or slight” (sub) and “to dislocate” (luxate). So the term ‘vertebral subluxation’ literally means a slight dislocation or misalignment of the bones in the spine.”
Mikey, here’s a challenge for you; provide some evidence, any will do, that shows the existence of a subluxation. Since no such evidence has ever been produced (due to it not existing), you will have your work cut out.
Secondly, you disrespectful arse, it is Professor Ernst, at the very least Doctor. If you had a thousandth of his knowledge, skills, or education, it would improve your current levels by a thousand times.
You are a typical chiro, overblown and full of it. Also typically, you cannot write proper English to save yourself. For someone who is not even allowed to lance a boil, your arrogance and ignorance are in equal measure.
This isn’t a situation that needs to be addressed. It isn’t about the victims/suckers/true believers. It’s about those peddling disproved, or yet to be proved, claims.
Yes, she may feel better for a bit. However, she was lied to by a con artist or mislead by a well meaning, but undereducated, person that really shouldn’t be doing anything that resembles medical treatment.
The hard thing is how to talk to this sort of person in a manner that doesn’t make them feel like an idiot or a victim but makes them realise that while they may “feel better” the next “patient” that was treated was given advice against vaccination their kids.
how to address that sort of person is a relevant question, ok.
how to make sense out of two deeply-felt and correct yet opposing views is another question, a question that is relevant to lots of people. and it’s the question addressed here.
Fair. I think I spend too much time arguing with irrational supporters of alt-med in stupid places (twitter.) Burnout is a thing, yeah? My tolerance is low for some of these people. :/
Bringing the good therapists down…who wants that?
I’m not quite certain what you try to say here, but taking SCAM seriously, and trying to put it on equal footing with real medicine DOES bring therapists down – the real ones, who actually know things about health and sickness because they spent at least ten years studying it in a structured, science-based manner. If the field of real medicine becomes infiltrated with quacks and woo-pedlars (e.g. through so-called ‘integrative’ medicine), then this will inevitably degrade the quality of health care.
Or, like the metaphor says: ‘integrating’ apple pie and cow pie doesn’t make the cow pie any better – it just makes the apple pie worse.
Having heard this line from ex-clients of psychodynamic psychotherapy, where they have left the better part of their financial resources to be told that they are not who they thought they were on extremely shaky theoretical bases, I don’t even know if obliging the practitioners of this dodgy modality to stop calling themselves “therapists” would save the clients from themselves.
Bjorn
Cool
Since I don’t know anything and you know everything…. you can explain it to me.
I’m listening.
” Feeling better is not necessarily a therapeutic aim.”
Classic.
If feeling better was the main therapuetic aim this would be easy to achieve by giving all your patients morphine (or cocaine, lorazepam or whatever).
Come to think of it, what about cancer screening? Most people attending for a mammogram, a stool test for blood or a cervical smear feel completely well, so any subsequent treatment cannot possibly make them feel better than they feel already, even if it saves their life (and I am not going to claim that you never feel worse after cancer surgery, radiotherapy, chemotherapy or other treatment for malignant disease).
Or what about treatment for hypertension, early type II diabetes, hypercholesterolaemia? Yes, of course weight loss and exercise can make you feel much better but that isn’t the therapeutic aim.
What about vaccination? Malaria prophylaxis? Heparin injections in people undergoing surgery?
What about physiotherapy (which in my experience is often very painful)? Or indeed any treatment where the primary aim is to restore function?
Emergency treatment of overdoses?
And for that matter, what about the treatment of drug addiction? Or other psychiatric problems such as hypomania (if you ask a manic patient they will tell you that they have never felt better).
Do you guys have any idea what real doctors do all day?