I was alerted to an article that makes several interesting points about the current popularity of so-called alternative medicine. Here is a section of it:
The rise of alternative medicine invites the question, what is conventional medicine doing, or not doing, that leads to all this alternative medicine? Here are some hypotheses that I invite you to comment on.
1. Time. Over the short span of my career, visits to conventional medicine providers have gotten shorter. A physician with an established practice can make a 20 minute visit work for most patients but for a less experienced doctor, or one seeing new patients with whom they don’t have an established relationship, or even a seasoned practitioner with an established practice who is just having a bad day, 20 minutes is not enough. This leaves patients wanting the greater time and attention that alternative medicine providers usually spend with patients.
2. Better use of placebos. I use the term placebo with absolutely no negative connotations. As I wrote above, and as I have written in this space, the use of the placebo effect, usually in the form of a therapeutic relationship, is a critical part of conventional and alternative medicine. Because conventional medicine does not depend on the placebo effect – your electrophysiology cardiologist can be an uncaring jerk and still effectively ablate your atrial fibrillation – we have gotten lazy in its use.2 Therefore, for the problems for which we have no real solutions, alternative medicine practitioners often do a better job.
3. People value what they pay for. In the US, and in most developed counties, people do not pay directly for their conventional care. On the other hand, it is the rare insurance policy that pays for acupuncture, chiropractic manipulation, or a consultation with a naturopath. Cognitive dissonance occurs when people are faced with the possibility that what they spent their hard-earned dollars on didn’t work. We resolve the dissonance by convincing ourselves that the treatments we paid for did work.
4. The downside of evidence-based medicine. It hurts me to propose this. Practicing evidence-based medicine entails integrating clinical experience and expertise (science knowledge) with the best available evidence from systematic research. […] conventional doctors often use practices not supported by robust studies. Chapter 2 in Ending Medical Reversal tells us how bad we are at knowing something works just based on our practice experience.3 That leaves science. We are in an age where education and an understanding of science can be a liability. Anybody who knows how to use social media can convince millions that something, anything, is supported by “their science.” Many people regard a treatment based on “rebalancing your life force” or “natural immunomodulators” to be as likely to be effective as ones based on actual biochemistry, immunology, and pathophysiology.
Has the articulation of evidence-based medicine opened the door to alternative medicine practitioners? If we all practice (some occasionally, some always) without data, if we can all quote “clinical experience”, if we all claim that “science” supports our treatment, what does conventional medicine offer that alternative medicine cannot?
In my ideal world, conventional and alternative practitioners would work together. Conventional doctors would diagnose, treat, and prognosticate as best as they can. They would nurture helpful therapeutic alliances with patients. They would also recognize that there are many symptoms that we cannot adequately treat and syndromes that we do not yet understand. Patients with these symptoms and syndromes would be referred to alternative medicine providers. These providers would see if what they have to offer can help. They would also refer back to traditional doctors if the situation changed, progressed, or if findings concerned them.
__________
2 It is not uncommon that I have to encourage trainees to “sell” their recommendations. This is important not only to get the patient to try the meds but because, in the short term at least, belief that a treatment will work might be the most important aspect of its pharmacology.
3 I still haven’t gotten over the commenter who, after I wrote that one of the things that makes me think masks are effective for COVID is that I worked, unvaccinated but masked for 9 months without getting COVID, asked me if I also put tinfoil inside my white coat.
END OF QUOTE
I disagree with several points the author makes here. Nevertheless, his overall notion -namely that conventional medicine is partly the cause for the popularity of so-called alternative medicine – is correct, in my view. I have often stated that modern medicine often lacks time, compassion, empathy and understanding. Yet patients frequently crave these qualities. Many practitioners are particularly good at providing them, and it is little wonder that patients then seek their help.
The bottom line is that many conventional medics might need to re-learn the necessary skills; and for doing so, they could do worse than to look at the ‘bed-side manners’ (as we used to call this aspect of patient care) of practitioners of so-called alternative medicine.
12 Responses to Does Conventional Medicine Invite the Rise of Alternative Medicine?
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I think the main problem is rather that so-called alternative “medicine” is legally allowed at all in the first place. Ordinary people have no clue about evidence or what “proved” means, nor any clue at all about how the body works in health and disease and what is reasonable to expect from a treatment.
But everyone knows the difference between fraud and honest business, and that fraudulent business will be punished by law.
So, if a medicament or treatment of any kind is offered openly by pharmacies and persons who look exactly like health care personell and they are not being arrested for fraud, then the conclusion will be that they are legit and worth spending money on.
What do you think?
interesting point!
but what would you suggest to be a reasonable solution?
Make fraud equally illegal in all its forms – including quackery.
If I sell a product with false promises, then I will be reported to the police, arrested, interrogated, and perhaps sentenced to some kind of punishment.
EXCEPT if my product promises health and longevity without any evidence to that effect!
Isn’t it unbelievably preposterous and inconsistent?
A parallel example: Many years ago a man in Sweden sold watches by mail orders and quickly earned a lot of money (because the parcels had to be prepaid).
But somehow (don’t ask me how) the customers noticed that there were no works in the watches and that the hands were merely painted on the watch-face.
So he was sued and eventually fined for fraud.
In his defence during the trial, he insisted that the watches showed the correct time twice a day. Although very true, neither the court nor the customers found that claim valid at all, just plain silly.
In my view, the defence of SCAM is even below that silly level. Even if it occasionally or even regularly “works”, that itself is not a valid argument. One can’t base an honest business on painted hands/placebo effects. Those watches did irrefutably show the correct time regularly for all the customers, but the placebo effect is estimated to affect less than 40 percent of patients. And that still only subjectively!
A 20 minute consultation? I should be so lucky. 10 mins at my primary care practice.
Or, as I once stated:
“And why do critically-minded academics in particular rely on a therapy that has “no effect beyond the placebo effect”?
The only plausible explanation:
THEY deliberately opted for homeopathy after conventional medicine had nothing more to offer them apart from side effects
In reality, THEY experience effects that cannot be explained in any way by the placebo effect
because
– Effects occur regardless of the time spent and the treatment,
– effects sometimes do not occur with the first dose despite a long medical history and often only occur with further
exploration and administration of the remedy
– effects are often so immediate and pervasive that a coincidence or placebo effect is as likely as the (skeptical)
proverbial “drop in the ocean”
– THEY do not suffer from the mental flat-earth block of “no material matter, no effect”
– THEY observe with an open mind and register that healings take place for complaints for which conventional
medicine had nothing to offer them
– THEY accept [!] that homeopathy cannot make any absolute promises of healing
– THEY know that [many] personal experiences of therapist and patient also contribute to the evidence and are
equivalent to the studies (see below)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2349778/pdf/bmj00524-0009.pdf
David Sackett:
“….Good doctors use both individual clinical expertise and the
best available external evidence, and neither alone is enough.
Without clinical expertise, practice risks becoming tyrannised
by evidence, for even excellent external evidence may be
inapplicable to or inappropriate for an individual patient.
Without current best evidence, practice risks becoming
rapidly out of date, to the detriment ofpatients…….”
Translated with DeepL.com (free version)
You are not so good with logic? In any case, your “plausible” explanation is for the trash can.
BTW, it is shameful that you, a believer in homeopathy, want to involve one of the pioneers of EBM for your SCAM propaganda.
QUOTE
The alchemists of alternative medicine – part 7 ‘hoisted on the petard’ of EBM
2014‑02‑14
https://edzardernst.com/2014/02/the-alchemists-of-alternative-medicine-part-7-hoisted-on-the-petard-of-ebm/
The most widely used definition of EVIDENCE-BASED MEDICINE (EBM) is probably this one: The judicious use of the best current available scientific research in making decisions about the care of patients. Evidence-based medicine (EBM) is intended to integrate clinical expertise with the research evidence and patient values.
David Sackett’s own definition is a little different: Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
…
Advocates of alternative medicine have been particularly vocal in pointing out that EBM is not really applicable to their area. However, as their arguments were less than convincing, a new strategy for dealing with EBM seemed necessary. Some proponents of alternative medicine therefore are now trying to hoist EBM-advocates by their own petard.
In doing so they refer directly to the definitions of EBM and argue that EBM has to fulfil at least three criteria: 1) external best evidence, 2) clinical expertise and 3) patient values or preferences.
Using this argument, they thrive to demonstrate that almost everything in alternative medicine is evidence-based. Let me explain this with two deliberately extreme examples:
CRYSTAL THERAPY FOR CURING CANCER
There is, of course, not a jot of evidence for this. But there may well be the opinion held by crystal therapist that some cancer patients respond to their treatment. Thus the ‘best’ available evidence is clearly positive, they argue. Certainly the clinical expertise of these crystal therapists is positive. So, if a cancer patient wants crystal therapy, all three preconditions are fulfilled and CRYSTAL THERAPY IS ENTIRELY EVIDENCE-BASED.
CHIROPRACTIC FOR ASTHMA
Even the most optimistic chiropractor would find it hard to deny that the best evidence does not demonstrate the effectiveness of chiropractic for asthma. But never mind, the clinical expertise of the chiropractor may well be positive. If the patient has a preference for chiropractic, at least two of the three conditions are fulfilled. Therefore – on balance – chiropractic for asthma is [fairly] evidence-based.
The ‘HOISTING ON THE PETARD OF EBM’-method is thus a perfect technique for turning the principles of EBM upside down. Its application leads us straight back into the dark ages of medicine when anything was legitimate as long as some charlatan could convince his patients to endure his quackery and pay for it – if necessary with his life.
@Heinrich Hümmer
Certainly, if real medicine can’t offer a solution for someone’s medical complaints, then they are more likely to try quackery. Not because they have an innate belief in quackery, and certainly not because there is a lot of evidence that it works, but because homeopaths and other quacks claim that they can often provide a solution. However, the totality of available evidence clearly says that these claims are simply untrue. Homeopathy does not work beyond placebo.
Well, there are several other effects apart from ‘pure’ placebo that contribute to the illusion of efficacy. These are, among others, regression to the mean and effects due to expectation bias and positive social reciprocity in interaction with the homeopath. However, no effects could ever be positively attributed to the shaken water or sugar crumbs that homeopaths falsely claim to be ‘medicines’.
‘Effects’ of this kind also regularly occur in real healthcare. Many people who go to the dentist with a toothache often feel a LOT better once in the dentist’s waiting room. The severity of complaints such as pain and discomfort are strongly linked to a patient’s mental state.
And talking about ‘likely’: sudden improvements of this kind are far more likely than the chance that shaken-water magic actually works (i.e. the notion that a totally absent substance has a strong, highly specific effect).
Interesting comparison, and – as usual with homeopaths – you got it exactly backwards:
– First of all, it is belief in homeopathy that closely resembles belief in a flat earth: both kinds of believers trust and accept what they think they see, wilfully ignoring and even rejecting any evidence that they are very, very wrong, as well as any explanations why they are wrong.
– Second, there is of course an immaterial phenomenon that can have certain effects called ‘electromagnetism’, and it is very well understood. However, electromagnetism requires physical matter in order to generate as well as detect fields. Where there is no matter present, this absent matter cannot engender any electromagnetic effects.
Homeopaths make the utterly ludicrous claim that absent matter can have highly specific effects. So yes, the notion that you absolutely need physical matter to create any effects holds true; there is not a single experiment that supports homeopathy’s notion of specific but absent matter having any effects. All we have is homeopaths who observe patients’ conditions improve after their treatment, and who thus perpetrate the very human fallacy that this improvement must have been caused by the treatment. Again, they explicitly reject any more mundane, and far more likely science-based explanations such as the ones given above.
You clearly have no idea how wrong you are, and how badly you misrepresent Sackett’s work.
The huge fallacy you make here is the one known as ‘The plural of anecdote ≠ data’. Personal experiences (read: anecdotal evidence) from practitioners should ONLY be allowed to contribute to the body of medical knowledge if those anecdotes are confirmed by proper scientific research.
Just think about it: for thousands of years, doctors observed that patients often felt better after bloodletting, so they believed that bloodletting worked. We now know that they were all wrong.
Homeopaths observe that patients often feel better after taking their homeopathic sugar crumbs, so they believe that those sugar crumbs work. We know that they are wrong. Homeopathic preparations do not work, as there is not even ONE homeopathic preparation 12C+ that exhibits clear, consistent and repeatable effects beyond placebo in any experiment or trial you may care to specify.
But in spite of this very simple universal fact, homeopaths still keep believing – and claiming – that their long-outdated quackery really works. And they are both so arrogant as well as stupid that they refuse to admit that they are wrong.
Many of us Camists who suffered from EBM were pushed into CAM. So much for the evidence for some EBM treatments.
It aint fraud when informed people like me seek CAM treatments . Please show me evidence of fraud by CAM practitioners and non consent of patients.
Those of you happy with your EBM treatments don’t have to use CAM.
@JK
It is fraud when quacks claim or strongly suggest that their treatments have any effects beyond placebo, without mentioning that there is in fact no scientific evidence supporting those claims.
So the article states that CAM practitioners spend more time on consultations, make better use of placebos, people have to pay for CAM and EBM has a downside.
Seems like a reasonable article!