Informing people about so-called alternative medicine

Hardly a day goes by that I am not asked by someone – a friend, colleague, practitioner, journalist, etc. – about the evidence for this or that so-called alternative medicine (SCAM). I always try my best to give a truthful answer, and often it amounts to something like this: TO THE BEST OF MY KNOWLEDGE, THERE IS NO GOOD EVIDENCE TO SHOW THAT IT WORKS.

The reactions to this news vary, e.g.:

• Some ignore it and seem to think ‘what does he know?’.
• Some thank me and make their decisions accordingly.
• Some feel they better do a fact-check.

The latter reaction is perhaps the most interesting because often the person, clearly an enthusiast of that particular SCAM, later comes back to me and triumphantly shows me evidence that contradicts my statement.

This means I now must have a look at what evidence he/she has found.

It can fall into several categories:

• Opinion articles published by proponents of the SCAM in question.
• Papers that are not truly relevant to the SCAM.
• Research that provides data about the SCAM that does not relate to its effectiveness, e.g. surveys, or qualitative studies.
• Studies of the SCAM in question.

It is usually easy to explain why the three first-named categories are irrelevant. Yet, the actual studies can be a problem. Remember, I told that person that no good evidence exists, and now he (let’s assume I am dealing with a man) proudly shows me a study of it suggesting the opposite. There might be the following explanations:

• I did not know this high-quality study (e.g. because it is new) and my dismissive statement was thus questionable or wrong.
• The study draws a positive conclusion about the SCAM but this conclusion is not justified.

In the first instance, do I need to change my mind and apologize for my wrong statement? Perhaps! But I also need to explain that, even with a rigorous study, we really ought to have one (better more than one) independent replication before we start changing our clinical routine.

In the second instance, I need to explain why the conclusion is not justified. The realm of SCAM is plagued by studies with misleading conclusions (as regular readers of this blog know only too well). Therefore, this situation arises with some regularity. There are numerous reasons why a study can generate unreliable findings (as regular readers of this blog know only too well). Some of them are easy to understand others might be more difficult for non-scientists to comprehend. This means that the discussions with the man who proudly brought the ‘evidence’ to my attention can be tedious.

Often he feels that I am unfair to his favorite SCAM. He might argue that:

• I am biased;
• I lack an open mind;
• I am not qualified;
• I am changing the goalpost;
• I am applying double standards because much of the research into conventional medicine is also not flawless.

In such cases, we are likely to eventually end our discussions by agreeing to disagree. He will be convinced of his point of view and I will be convinced of mine. Essentially, we are more or less where we started, and the whole palaver was for nothing.

… a bit like this post?

I hope not!

What I have been trying to demonstrate is that:

1. SCAM enthusiasts are often difficult, sometimes impossible to convince;
2. research is not always easy to understand and requires a minimum of education and know-how.