Looking back, 2016 could be called the year of reactionary politics. Donald Trump was propelled to the presidency through widespread populism, helped by the fringe, conspiracy-theory laden alt-right community. A reactionary, antiestablishment sentiment prevails. The equally dissatisfied alt-med movement aims to have a similar disruptive effect. It certainly has some high-profile proponents: President-Elect Donald Trump has courted the community by tweeting about vaccines and autism while Jill Stein, the third-party presidential candidate and a physician, has explicitly attempted to merge alternative medicine culture with populist politics.
Alternative medicine is an innocuous, even attractive, term, framed as a healthy, natural option other than conventional medicine. What could possibly be bad about alternatives and nature?
The truth is, there’s little unconventional or natural about the factory production lines and multibillion-dollar industry behind most of the so-called alternative products used by millions of Americans.
Instead, much of alt-med is based on a deep distrust of for-profit medicine and science. Just as the alt-right community reacts broadly against the political establishment, the alt-med community seems more interested in reacting against the corporatization of medicine and nutrition and less about proposing its own reasonable, evidence-based alternatives.
Medicine is as vulnerable to populist and antiestablishment attacks as any other industry. Once defined by personal, one-on-one interactions between physicians and their patients, modern medicine is now undeniably a big-business endeavor. Mega-corporations have a growing influence in the field, providing the drugs and devices we use and conducting more and more of the clinical research that forms the foundation of modern medicine. The public is angered by the selfish way that some pharmaceutical companies behave.
But so are doctors. This shared ethical outlook should be strengthening the alliance between doctor and patient. Instead, we’re drifting apart. We need a new political movement to counteract this trend.
Alt-med attacks on doctors look similar to alt-right attacks on politicians. As a young physician, I admit that I’m idealistic about advocating publicly for patients regarding issues important to their health. I have no compunction about discouraging doctors and the media from promoting unproven alternative products.
Yet individuals like me who criticize unproven alternative health interventions are often accused of being shills for big corporations. Alt-med attacks on physicians recapitulate the tribalist left-right divide in politics by implying that doctors are either on the side of patients or they are on the side of pharmaceutical and medical device companies.
Some alt-med criticism is based in reality. Some pharmaceutical companies have skewed clinical trial results for their benefit and to the detriment of patients. Some companies have priced drugs to maximize profit rather than maximize the number of people they can help. There are bona fide cases of physician kickbacks from pharmaceutical companies. And new diseases have been invented just to sell pills rather than to address a real need. When the alt-med community discusses these problems, it isn’t wrong, though the facts are often exaggerated beyond recognition.
I and other doctors are connected to big business, whether we like it or not. You may see the pharmaceutical industry as bad, but should agree that it can make wonderful products that ease suffering and lengthen lives. I’m grateful I live in a world with antibiotics and Gleevec. Doctors are trained to put the needs of their patients first. Sometimes that means prescribing helpful drugs and, in the process, enriching large corporations. This puts doctors in a complicated position, because through our prescriptions we direct patients and insurers to flood pharmaceutical companies with billions of dollars. Yet we cannot control how that money is subsequently spent, whether on innovative research or protectionist lobbying.
You won’t see this nuance when reading popular alt-med publications. The narrative there is that pharmaceutical corporations are thoroughly evil and that physicians or scientists who endorse their products are morally equivalent to these “evil” organizations.
That’s the big lie getting between doctors and their patients. This is the conspiracy that unites alt-med with alt-right. When framed through a reactionary lens, politicians who interact with corporate leaders are automatically shills and doctors who prescribe drugs from Big Pharma are automatically corrupt. But politicians can’t ignore the importance of big business on American life and doctors won’t ever entirely divorce themselves from corporate medicine.
Doctors do, however, need to align themselves with patients and against amoral corporations as best they can. The medical profession must be vocal in criticizing the flaws of the industrial-medical complex and finding innovative ways to address the fact that we are inadvertently enriching corporations when we appropriately prescribe helpful medications to our patients. But we also need to address the unfair conflations and outright conspiracy theories that the alt-med community generates. It is harming the doctor-patient relationship and decreasing patient trust of physicians.
The distrust bred by conspiracy theories can also injure patients just as much as any disease. Vaccine-related conspiracy theories, for example, have caused a deadly polio outbreak in Pakistan.
Unfortunately, profits drive much of alt-med “fake news,” just as profitable advertising schemes back most fake news targeting the alt-right audience. When natural health publications peddle unproved therapies, that content is used to sell ads — and often their own treatments — for massive profits. Passionate advocates of alternative medicine who aren’t in it for money need to recognize that their work is also inadvertently enriching unethical corporations.
Doctors and patients need to make a new alliance beyond the usual one that takes place in medical offices and hospitals. Widespread distrust and cynicism of important public institutions such as the health care system are counter-productive. Pessimism erodes, rather than strengthens, our institutions. Doctors can’t counteract this reactionary trend by merely doing their jobs. It will require a larger social and political campaign where we listen to patient concerns about corruption and ineffectiveness then act together. Doctors and patients can and should address the unethical behavior of the medical establishment, whether it is peddling traditional remedies or alternative ones.
Benjamin Mazer, MD is a resident physician in pathology at Yale New Haven Hospital. His views are his own and do not represent those of his employer.
“Most people do not listen with the intent to understand; they listen with the intent to reply.” Stephen Covey
I agree that there are a handful of mainstream medicines that really work – antibiotics are one of them. But for most other medicines, meta analyses have shown that active drugs and placebos have similar effect sizes (see: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0062599).
Also, when considering the terrible side effects (and long term adverse effects) of things like psychiatric drugs that are prescribed today (these are medicines that drug companies come up with using a hit-or-miss approach), it would be definitely better off for a person to take a non-harmful product (that would help them as well – through “placebo effects”). So, if an alternative product is nontoxic, it should be allowed.
That still doesn’t mean even one altmed treatment works.
But do you agree that harms (both specific and non-specific) and nocebo effects must also be considered and weighed up against the potential benefits?
Alan: Expectations of a patient can play a really big role in their healing (check out the documentary “Brain Magic: The Power of Placebo” in ‘nature of things’). Also, I know so many people who ‘swear by’ natural remedies – these people can definitely benefit by their placebo effects. I have also heard that pharmaceutical companies need to present only two trials in order to get a drug approved – therefore, what the drug companies do is to conduct many many trials and present two trials that just happened to show results in a favorable direction for that drug. This situation makes us wonder if the promises that most conventional drugs make are genuine.
Also, we need to consider the possibility that science has not yet figured out how various altmed treatments work – science cannot simply assume that it knows all the answers and understands everything.
kdn said:
“Expectations of a patient can play a really big role in their healing (check out the documentary “Brain Magic: The Power of Placebo” in ‘nature of things’).”
Placebo effects certainly do exist, but their effects are frequently overstated. But do you think that’s all altmed practices are – placebos?
“Also, I know so many people who ‘swear by’ natural remedies – these people can definitely benefit by their placebo effects. I have also heard that pharmaceutical companies need to present only two trials in order to get a drug approved – therefore, what the drug companies do is to conduct many many trials and present two trials that just happened to show results in a favorable direction for that drug. This situation makes us wonder if the promises that most conventional drugs make are genuine.”
That may well be true to some extent but do you agree there’s no reason to suspect trials of, say, homeopathy are any different? And, of course, conventional treatments also come with placebo effects.
But in the UK, for example, homeopathy manufacturers don’t have to provide any evidence whatsoever that their product works! In fact, if there was good evidence, they would not be granted authorisation or registration as a homeopathic medicinal product. As I understand the USA situation, the FDA do not evaluate the evidence either – which is fortunate for the manufacturers, of course.
But why do you suppose there is this far lower standard for homeopathy? Why should they have to meet a low hurdle that requires not a jot of evidence of efficacy?
“Also, we need to consider the possibility that science has not yet figured out how various altmed treatments work – science cannot simply assume that it knows all the answers and understands everything.”
First, provide good evidence that they are, indeed, effective, then we can start to worry about how they might work.
Alan – There can be much more to altmed drugs than the placebo effect – science has not yet figured out the mechanisms in which they work. Therefore, these drugs should be allowed as long as they are nontoxic.
By the way, the placebo effect can be extremely powerful. One study that
investigated what aspect of knee surgery was giving relief to patients found that the placebo group (that received “fake” surgery) improved just as much as the other two groups! [reference: Moseley, J. Bruce, et al. “A controlled trial of arthroscopic surgery for osteoarthritis of the knee.” New England Journal of Medicine 347.2 (2002): 81-88]. There are other interesting studies – see below:
Crum, A. J. and Langer, E. J. (2007) Mind-set matters: exercise and the placebo effect. Psychological Science, 18, 165–171.
McRae, C. “Effects of Perceived Treatment on Quality of Life and Medical Outcomes in a Double-Blind Placebo Surgery Trial,” Archives of General Psychiatry. 61 (2004):412-20.
Crum, A. J. Mind Over Milkshakes: Mindsets, Not Just Nutrients, Determine Ghrelin Response- Health Psychology 2011, Vol. 30, No. 4, 424–429
Florent Lebon, (2010). Benefits of motor imagery training on muscle strength
Journal of Strength and Conditioning Research, 24(6)/1680–1687
Carvalho, C., Caetano, J. M., Cunha, L., Rebouta, P., Kaptchuk, T. J., & Kirsch, I. (2016). Open-label placebo treatment in chronic low back pain: A randomized controlled trial. Pain, 1-7.
kdn said:
“There can be much more to altmed drugs than the placebo effect – science has not yet figured out the mechanisms in which they work.”
As I said, should we not have the evidence that they do indeed work before wondering how they do? If they don’t work, there’s nothing to hypothesise about.
“Therefore, these drugs should be allowed as long as they are nontoxic.”
How would you know they were non-toxic? But it’s not even just a case of something being non-toxic: what matters is what harm they cause overall through specific and non-specific effects. Only then can any benefits be properly weighed up.
Considering that most altmed drugs have been passed on from generation to generation, most of them should be safe (otherwise they would have been eliminated long ago). In case there is a suspicion about their safety, an epidemiological study can be carried out. Also, do you know that psychiatric drugs that are prescribed today do more harm than good? Check out the report titled “The Case Against Antipsychotics: A Review of Their Long-term Effects” (it is accessible online). I am sure most conventional drugs in use today are mere placebos – as I mentioned in a previous post, most conventional drugs and placebos have similar effect sizes.
kdn said:
“Considering that most altmed drugs have been passed on from generation to generation, most of them should be safe (otherwise they would have been eliminated long ago).”
*Should* be safe? Are you willing to trust the manufacturers? Why should they get a free pass without having to demonstrate that their products are safe? But your assertion that they would have been eliminated long ago is fallacious – it’s an appeal to personal incredulity. But what about new homeopathic products? Zicam springs to mind.
“In case there is a suspicion about their safety, an epidemiological study can be carried out. Also, do you know that psychiatric drugs that are prescribed today do more harm than good?”
Are you suggesting we let a manufacturer sell whatever products they like and only do something if there is a suspicion about their safety? Seriously? Would you be OK if Big Pharma did that? I certainly wouldn’t! But if there is no mandatory monitoring system in place, how would you ever suspect?
“Check out the report titled “The Case Against Antipsychotics: A Review of Their Long-term Effects” (it is accessible online).I am sure most conventional drugs in use today are mere placebos – as I mentioned in a previous post, most conventional drugs and placebos have similar effect sizes.”
Again, nothing to do with altmed.
Arghh, back again. This article really has a straw man. A much greater danger to trust in medicine than alternative medicine, which is really complementary and not competitive in how it is used by many patients, is the proliferation of bad evidence. More and more research has shifted from academic grant-funded to sponsor-funded, and sponsors have a lot at stake in good outcomes. Of course there is objective research funded by sponsor companies. But some have questionable hypotheses, small sample sizes, omit facts, and hide evidence. JP Ioannidis’ famous PLoS Medicine study, Why Most Published Research Findings are False, is summarized in the AMA Journal of Ethics, When Research Evidence is Misleading, Virtual Mentor, January 2013 15:1 29-33.
I went through much of life trusting medical journals and RCTs as the gold standard of research for EBM. Then I saw how the sausage was made doing a couple of in-depth investigations of the gaps between purported safety and the reality of harm. Some gaps are chasms.
Each time there is an adverse event that is not a rarity or freak occurrence, or an added safety warning not disclosed up front, a black box warning, or a recall, there was a bit of a failure on the front end. Each time one experiences little to no improvement and instead side effects or even setbacks from proven treatments, and paradoxically good improvement from treatments not yet proven, it opens the eyes. Informed chronic disease patients become pretty good at reading medical journals, doing all kinds of networking, and working with physicians who bring complementary knowledge and skills to bear to improve their health. We prefer them to get along, respect each other, and in the best of all worlds, listen and learn from each other. There seems to be less dogmatism than in the past at the practitioner level. Not necessarily in professional associations which have a lot at stake, or in the media and blogs, where attracting eyeballs feeds more extreme positions.
Laura Henze Russell said:
“This article really has a straw man. A much greater danger to trust in medicine than alternative medicine, which is really complementary and not competitive in how it is used by many patients, is the proliferation of bad evidence.”
You’re right about alt med not being competitive: I’ve seen many quacks refuse to criticise, never mind condemn, bogus claims by other practitioners. It seems each knows their practice is on shaky ground and doesn’t want to rock the boat.
But it’s not the particular therapy that makes it complementary or alternative: it’s how it is presented and used. Many quacks seem to believe theirs is the one and only therapy and I’m sure you’ll agree that many altmed practitioners denigrate conventional medicine, sometimes to the extreme.
“More and more research has shifted from academic grant-funded to sponsor-funded, and sponsors have a lot at stake in good outcomes. Of course there is objective research funded by sponsor companies. But some have questionable hypotheses, small sample sizes, omit facts, and hide evidence. JP Ioannidis’ famous PLoS Medicine study, Why Most Published Research Findings are False, is summarized in the AMA Journal of Ethics, When Research Evidence is Misleading, Virtual Mentor, January 2013 15:1 29-33.”
Some of that is true and campaigns such as All Trials are working to improve the problem of Big Pharma hiding results and the Compare Trials campaign exposes the switching of outcomes – another way of ‘fiddling’ the results. The question this raises is whether the same issues are prevalent in altmed as well: I think it does – it seems that so many trials of, say, homeopathy are small, not properly blinded – if at all – and of such low overall quality that they cannot be taken seriously. The other question this raises is what the altmed industry is doing about this. Not much, it seems to me. In fact, Dr Ben Goldacre, who set up Compare Trials, has already exposed outcome switching in a trial looking at acupuncture and Alexander Technique.
“I went through much of life trusting medical journals and RCTs as the gold standard of research for EBM. Then I saw how the sausage was made doing a couple of in-depth investigations of the gaps between purported safety and the reality of harm. Some gaps are chasms.”
Again, the same applies to altmed.
Ioannidis specifically HATES being cited in this way as he is all on the side of evidence although he wants to improve its quality, so I wish you would have the respect to NOT cite him in this way.
how did they do that?
they bought the research. they subsidise the universities. they pay the doctors to attach their names to rank research .
Did they? I’d be interested to see your evidence that they ‘bought’ the research in some specific case.
Alan,
Here is a Cochrane collaborator’s commentary on the overuse of drugs and their understated dangers.
https://www.ncbi.nlm.nih.gov/pubmed/25355584
There is plenty of evidence in the headlines on opioid addiction alone. Not to mention side effects of statins, antidepressants and even antibiotics — superbugs are ascending and we didn’t know what we were doing when using them in our ignorance of the microbiome. They are still widely overprescribed. Not to mention, that the effects of vaccines in shifting the microbiome to favour more dangerous pathogens than those targeted by the vaccine itself, which is an almost uninvestigated field but the few studies that do exist are frightening and it is one of the reasons the nasal flu vaccine is not on the market in the US today.
Your citation of polio re-emergence in Pakistan is part of the same problem. Wild type polio is not the current problem. It is vaccine-derived polio virus (VDPV) . Read the literature. Same with the current outbreak of mumps. It is the result of a failing vaccine and the emergence of a different strain of mumps. It is affecting the vaccinated predominantly, but now jeopardizing the unvaccinated more, as in the case of the live virus shedding of marek’s vaccine virus in chickens which is well-documented in the literature. Vaccines, like antibiotics are not the be-all and end-all of disease anymore than antibiotics are. They are a tool. What are we to do ? Have a never-ending list of vaccines added to the current regime to fight all of the 100 new and soaring autoimmune diseases?
And nature has ways around them. The best defense against disease in the alternative medicine worldview is a person who is healthy, with a healthy immune system that has not been damaged by toxins, poor diet, lack of exercise etc.
Show me the evidence of the great harm of multivitamins? The thousands of deaths from vitamin D overdosing? (which btw, the alt practitioners were ahead of in prescribing by two decades while mainstream doctors told their patients to stay out of the sun and slather themselves in paraben-loaded skin creams) Show me the people addicted to their coconut oil and out on the street. Mainstream medicine’s complaints about the practices of alt med are a joke. It kills more people in an hour than alt med has negligently killed in a decade. Iatrogenic disease is rampant.
Jeff
I don’t know why you’re referring to overuse of drugs and their understated dangers: they have nothing to do with altmed.
Have a happy, healthy, New Year everyone.
Same to you, Laura. Happy New Year when it comes.
Mainstream medicine and dentistry is doing enough harm to itself through installing medical and dental devices without prescreening individual patients for immune tolerance vs. reactivity. A rather unenlightened and outdated practice, but the law of the land via outdated FDA device laws and regulations, and the dated guidelines of medical and dental practice and insurance programs. See my recent StatNews piece,
https://www.statnews.com/2016/12/21/medical-devices-safety-congress/.
Perhaps more energy should go into righting its own ships so less people capsize and are thrown overboard to flail and grab onto lifepreservers that help bring them back to shore.
As someone once put it: problems with aircraft failures does not mean magic carpets are a safe and effective mode of transport.
what is “quackery one year,” is medical truth the next. Semmelweiss was a quack for advocating handwashing because it pointed to iatrogenic disease. They killed him. Now there is a university in his name. Same story repeats. The last few years brought “leaky gut” (now called gut permeability in mainstream practice), the microbiome and dysbiosis and chelation cold hard science to support them — though your stripe of proud skeptic entrenched by smug smart thinking scoffed at it 10 years ago. The extensive damage done by psychotropic drugs to two of children (documented in Anatomy of an Epidemic) is now being remarked upon by Scientific American. History will mark you like those who put Semmelweiss to death in an asylum while women died.
Jeff
What is it that makes some things that may have been regarded as quackery one year into medical ‘truth’ the next?
Alan,
I cited several examples. Handwashing was quackery and Semmelweiss was institutionalized for advocating it. Now to do otherwise would be considered quackery.
The theory of a “leaky gut” has been championed in alt-med circles for decades, as has dysbiosis. Leaky gut was ridiculed (and still is on basic public health agency websites. But In the past five years (search “gut permeability” and “dysbiosis” on PubMed) the science has exploded and see how this theory is now central to understanding a host of immune-mediated and chronic diseases.
This website carries another story today on how a doctor examining a “discredited” theory of chelation therapy is now expanding his work because it is not dangerous after all and may prove to be very helpful.
A recent nobel prize in medicine went to a Chinese researcher who isolated an effective anti-malarial compound from a traditional Chinese herb — yet mainstream medicine dismisses herbal medicine outright. So many studies are looking at the effectiveness of compounds from turmeric (look up its active ingredient curcumin on PubMed) and yet so-called “evidence-based” practice excludes these hundreds of studies.
Patients are put on drugs like opioids and antidepressants without a second thought by the same doctors who proclaim vitamin C dangerous. It’s utter nonsense and doctors have excluded themselves from what could be vital lifesaving tools for their patients because they are wedded to pharmaceutical salesmen and they don’t even know it.
Functional medicine is now growing by leaps and bounds. Outdated doctors who rely on the old one-drug-one effect paradigm which has failed miserably will be gone in a generation (two at most) Y
The Mayo Clinic now boasts of issuing 30,000 prescriptions per day — as if this says ANYTHING about how many people it heals — to live their lives both symptom and drug-free. People are catching on that the old paradigm of treating symptoms has failed. And now the science is catching up so fast — and you are running to catch the bus that just ran you over. ou will be mocked like bloodletters.
Jeff
You only answered my question in a round about sort of a way: I didn’t ask about hand-washing or chelation (which is routinely claimed by altmed proponents to cure all sorts of things) or whatever, but the answer I was looking for was ‘evidence’. But that simply raises the questions: what do we call something that does not have good evidence to support its use and should we wait for that evidence or for science to catch up before promoting it and calling it ‘medicine’?
Alan,
Well, right now we’re calling that sort of medicine “alternative medicine”. But science is catching up, as in the case of chelation and leaky gut. The objection from many alt practitioners too, is that the evidence was there for a very long time, but ignored by mainstream medicine because pharmaceutical interests obscure it. Look at vitamin C, for example. Studies go back to the 1940s (at least) showing that vitamin C is a powerful treatment for everything from post-herpetic neuralgia pain (currently treated with very dangerous combinations of addictive opioids) to infection. That study was halted when pharmaceutical drugs ascended. Today, young physicians will snort that vitamin C is “snake oil” but they are really only spouting what they have been told by the pharma industry that doesn’t want them to look at tool which can’t be patented. In 2015 PLoS One carried a study examining the use of IVC because it is the most frequently used alternative therapy. To their surprise, they found it “remarkably safe” http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0011414
Here doctors go on about the dangers of multivitamins when the drugs they prescribe are the third leading cause of death! Surely doctors should want to claim this toolkit back for themselves, but they haven’t and they’ve settled with being prescribers of drugs that lead to polypharmacy without curing anyone.
The evidence is there Alan. Look for it. And not on a GSK or Merck sponsored website.
Jeff said:
“Well, right now we’re calling that sort of medicine “alternative medicine”. But science is catching up”
I’m not sure I have your faith that science will ‘catch up’, but if and when it does, I’m sure we’ll all hear about it. Meantime…
“The objection from many alt practitioners too, is that the evidence was there for a very long time, but ignored by mainstream medicine because pharmaceutical interests obscure it.”
How do they do that?
“That study [on Vit C] was halted when pharmaceutical drugs ascended. ”
How was that done?
“Here doctors go on about the dangers of multivitamins when the drugs they prescribe are the third leading cause of death! Surely doctors should want to claim this toolkit back for themselves, but they haven’t and they’ve settled with being prescribers of drugs that lead to polypharmacy without curing anyone.”
Well, there is certainly some evidence that some multivitamins can be harmful if taken to excess, but not that much that many actually need to take them. But how many deaths have been saved by homeopathy and the like?
“The evidence is there Alan. Look for it. And not on a GSK or Merck sponsored website.”
I’ve never mentioned any Big Pharma website, but did you know that Merck made a range of homeopathy products until fairly recently?
Alan, Thank you for the correction. I meant serious infection, not sepsis. There is no edit function.
No problem, Laura.
Infections do sometimes clear up without any help, of course.
Respectfully disagree that all patients who use alternative medicine reject conventional medicine, and vice versa. Patients pick and chose what works, and are grateful for both. Why set up a straw man?
A PubMed search on acupuncture+clinical+trials brought up this:
Efficacy and safety of penetration acupuncture on head for acute intracerebral hemorrhage: A randomized controlled study.
Wang HQ, Bao CL, Jiao ZH, Dong GR.
Medicine (Baltimore). 2016 Nov;95(48):e5562.
In addition, there are various articles listed with protocols for clinical trials, so perhaps more will be forthcoming.
Another notes hypothesized impact on the vagus nerve, which is taking a bit of a star turn in neurology these days. http://www.wsj.com/articles/nerve-treatment-when-drugs-fail-1480958017
Laura Henze Russell said:
“A PubMed search on acupuncture+clinical+trials brought up this:
Efficacy and safety of penetration acupuncture on head for acute intracerebral hemorrhage: A randomized controlled study.
Wang HQ, Bao CL, Jiao ZH, Dong GR.
Medicine (Baltimore). 2016 Nov;95(48):e5562.”
From the paper:
“Eighty-two patients with acute ICH were randomized to receive penetration acupuncture treatment on head combined with conventional treatment (treatment group [TG]) or conventional treatment only (control group [CG]).”
It’s a small trial, but this is a trial design much beloved by proponents of all sorts of alt med – it is an A+B versus B design and these will always generate positive results: adding one treatment (in this case, acupuncture) to another (conventional) – particularly when that treatment involves a lot of interaction with the practitioner – will always add benefits from non-specific effects and it cannot provide any evidence that acupuncture provides any specific benefits.