Alternative and complementary medicine have seen a spike in popularity in recent years, with celebrities often touting the benefits of their own experiences in the media and practitioners promoting “cures” for everything from migraines and stomach ulcers to dementia and cancer.
To be clear, ‘alternative’ usually implies a treatment is used instead of conventional medicine, while ‘complementary’ therapies are used alongside regular medical treatments. Together, these two types of therapy are known as ‘CAM’, and their use is on the rise.
According to a study by the National Institutes of Health, the prevalence of CAM use increased by 25 percent from 33.8 percent in 1990 to 42.1 percent in 1997. By 2007, well over 50 percent of Americans reported using some type of CAM therapy in their lifetime, and 38 percent had used CAM in the previous 12 months.
Unfortunately, media and online coverage of alternative therapies often doesn’t tell the whole story or include professional medical advice, and can be very misleading. Meanwhile, proponents of CAM go to great lengths to manipulate the science behind their claims, in turn instilling false hope in patients and spreading dangerous misinformation to the general public.
“Natural is better”
One of the big selling points advocates of alternative therapies use is to claim that conventional treatments are ’toxic’ while their favored treatment is ‘natural’, implying that natural is somehow better.
Many treatments for cancer and other diseases were originally derived from naturally-occurring substances. The chemotherapy drug Taxol, created from a compound found in yew leaves, is a prime example. Conversely, some of the most poisonous substances in the world – ricin, cyanide, arsenic, hemlock, snake venoms and mercury to name but a few – are all entirely natural.
Furthermore, alternative ‘natural’ therapies are not guaranteed to be safe — and in fact, many of them have been found to be harmful. Examples include a serious risk of cyanide poisoning from laetrile, permanent scarring or disfigurement from cancer salves, and bowel damage, blood salt imbalances or even life-threatening septicaemia caused by coffee enemas.
The underlying problem here is that proponents of “natural” therapies can never seem to settle on what distinguishes “natural” from “unnatural” nor why one is better than the other. With no exact definition, the word “natural” can take on a number of different meanings, thus allowing proponents of “natural” medicine to shift their arguments without directly contradicting themselves — leading to another fallacy known as equivocation.
“But it works… I read it in the news!”
Stories in the news about alternative therapies are usually framed in the words of a patient talking about their own journey through cancer or another life-changing illness. These anecdotes can be powerful and tend to appeal to our emotions, but what they fail to offer is scientific evidence that a treatment is effective or safe.
In many cases, news reports provide incorrect or confusing medical information, such as misreporting the type and stage of disease or the true chances of survival, and failing to point out any conventional treatments that were used alongside or before seeking alternative therapy.
In some cases this may be the result of accidental omissions or errors, especially if a reporter is only relying on the patient themselves as the source of their story.
Diseases like cancer are characterized by complexity and variability, and without access to detailed medical records – which are confidential – it is impossible to paint a fully accurate picture of an individual’s recovery and whether alternative therapies played any role in their recovery.
More worryingly, there are some cases where evidence points towards a murkier interpretation of ‘truth’ and fact.
For example, Australian blogger Belle Gibson built a large media profile and business around the story of having apparently ‘healed herself’ of a brain tumor through diet and lifestyle changes, but has now admitted that she never actually had cancer at all.
People pushing alternative therapies frequently wheel out stories from ‘survivors’ who are apparently alive due to their treatments, yet without providing solid evidence to prove it is true. This raises false hope and unrealistic expectations that there is a hidden miracle cure that can be unlocked for the right price, or by eating exactly the right foods. As a result, patients and their loved ones may feel guilty or angry for not trying everything that they possibly could have done, despite there being no evidence that such treatments would have helped.
Stories of people ‘healing themselves’ through diet or other therapies make good headlines. However, if the same person later dies from their cancer it often goes unreported, leaving readers with the misconception that the alternative treatment was a success. Notably, these intentional omissions pervade scientific reporting on CAM, as well. As retired psychiatrist and consumer health advocate Dr. Stephen Barrett, M.D., told the Associated Press, “there’s been a deliberate policy [within CAM] of never saying something doesn’t work.”
Understandably, there may be huge reluctance among family members to admit that alternative therapy failed, especially if it came at a high cost or reduced quality of life. This problem goes back more than a century, as detailed in a paper published in the British Medical Journal from 1911. It reveals how an alternative “cancer curer” continued to reassure a husband that his wife was recovering after she had actually died, even going so far as to continue applying dressings to the poor woman’s body. Her husband and friends were “ashamed of having been duped and they kept quiet,” while the quack went unpunished.
“It worked for me [or my mother, neighbor, coworker, etc]!”
Many proponents of CAM were turned onto alternative medicine through personal experience — that is, they believe CAM is effective because they or someone they know has reportedly benefited from it. Underlying this belief is the post hoc, ergo propter hoc (after this therefore because of this) fallacy, which is based on the the mistaken notion that simply because one thing happens after another, the first event was a cause of the second event.
Dr. Edzard Ernst of the Institute for Science in Medicine — a physician who formerly advocated for CAM but later came to denounce it after years of critically evaluating the evidence — described this fallacy in detail in a 2013 article about alternative medicine:
If a patient receives a treatment and then gets better, what could be more logical than to assume that the treatment was the cause of the improvement? This conclusion seems as obvious to patients—and many clinicians—as it is fallacious. Proponents of [CAM] employ this fallacy incessantly to convince us that ineffective treatments are, in fact, effective.
Apart from the treatment per se, a whole range of phenomena exists that can cause or contribute to improvement: the placebo effect, the natural history of the illness, the regression towards the mean and so on. It means that patients can get better after administering useless or even mildly harmful remedies; subsequently is not the same as consequently. Causal inferences based on anecdotes are therefore highly problematic and certainly no sound basis for robust conclusions about the efficacy of therapeutic interventions.
In other words, it’s entirely possible that people who have used CAM have felt better afterwards — but that doesn’t mean they felt better because of CAM.
Where’s the evidence?
When a doctor recommends a course of treatment their decision is based on the best available information about the chances of saving or prolonging a patient’s life, along with any risks and benefits.
Sadly we know that in too many cases even the best treatments can fail, which is why scientists are continually researching more effective ways to diagnose and treat serious diseases like cancer. Even so, the treatments we have today – including surgery, radiotherapy and chemotherapy – have helped to double cancer survival rates since the 1970s.
It’s understandable that people want to hang on to any glimmer of hope that they or their loved one can be cured, particularly when facing a terminal diagnosis. But despite what alternative therapists may claim, they do not have evidence to support the effectiveness of the treatments they offer. Yet they do stand to make money – a lot of it, in some cases – from selling ineffective treatments and advice. In 2007, U.S. adults spent $33.9 billion out-of-pocket on CAM, making up 11.2 percent of total out-of-pocket spending on healthcare. And as the monetary incentive has grown, we’ve seen the greedy side of CAM practitioners rear its ugly head.
Of course, pharmaceutical companies stand to make money from cancer treatments, too — but they must provide evidence of the effectiveness, safety and side effects of their treatments through lab research and clinical trials. That’s part of what makes new drugs and therapies so costly — research is expensive and when lives are on the line, cost-cutting shortcuts are not an option.
This highlights the major difference between the medicine practiced by board certified, classically trained physicians and that of alternative practitioners. That difference is research and data.
In conventional medicine, the safety and effectiveness of drugs and therapies that make it into clinical practice are supported by years — often decades — of scientific data. This information is then assessed by doctors and healthcare providers when deciding whether a treatment should be made available for patients and paid for by the health service or insurance.
This is in stark contrast to CAM, which, by definition, is not scientifically-proven. As the National Science Foundation states, “alternative medicine refers to all treatments that have not been proven effective using scientific methods.” If there was good evidence that alternative treatments work, then they would stand up alongside conventional treatments when put to the test. But time and time again we’ve seen that they don’t. This means that more than 10 percent of all out-of-pocket spending on healthcare each year goes toward therapies that have not been shown to be helpful or safe.
But the potential costs to patients of placing their hopes in unproven “alternative” drugs and treatments go beyond financial ones.
The hidden costs
One of the biggest risks of seeking alternative therapy is postponing or declining evidence-based conventional treatment, which might otherwise prolong or even save a patient’s life.
Perhaps the most famous example is Steve Jobs, the former head of Apple. He was widely reported to have pancreatic cancer, but in fact he had a very different type of cancer called a neuroendocrine tumor which started in his pancreas. After diagnosis he refused medical advice to have surgery and chemotherapy, opting for alternative therapies such as acupuncture, juicing and other treatments he found on the internet.
By the time Jobs finally agreed to surgery, his cancer had spread and was untreatable. There is no way of knowing if delaying conventional treatment made a difference to his ultimate outcome, but it’s a decision he reportedly regretted.
Then there is the issue of pursuing unproven alternative treatments overseas. Traveling abroad can be risky if a patient is unwell, even leading to emergency hospital admissions if anything goes wrong or their health deteriorates unexpectedly. Because arranging appropriate insurance can be difficult, sorting out any problems that occur while abroad can be extremely costly and stressful.
Another risk is that patients choosing to use alternative therapies may miss out on opportunities for palliative care, such as effective pain relief or reducing the symptoms of advanced cancer with radiotherapy or drugs. Although they cannot provide a cure, palliative therapies can make a big difference to quality of life in the end stages of cancer. Moreover, the pursuit of unproven alternative treatments – particularly abroad or involving arduous and restrictive regimes – robs people of valuable time that they could be spending with family and friends.
Making informed choices
Patients struggling with complex diseases deserve to have the in-depth information they need to make important decisions about their course of treatment. Yet the very nature of CAM precludes this type of informed decision-making.
The standards of science hold that people who make the claims bear the burden of proof — it is their responsibility to conduct rigorous studies and report the results in sufficient detail to permit evaluation and confirmation by others. But instead of subjecting their work to these scientific standards, promoters of CAM often try to change the very rules by which they are judged and regulated: they regard personal experience, subjective judgment, and emotional satisfaction as preferable to objectivity and hard evidence, and instead of conducting scientific studies, they use anecdotes and testimonials to promote their practices and lucrative lobbying to keep regulatory agencies at bay.
As noted in a 1998 New England Journal of Medicine editorial:
What most sets alternative medicine apart . . . is that it has not been scientifically tested and its advocates largely deny the need for such testing. By testing, we mean the marshaling of rigorous evidence of safety and efficacy, as required by the Food and Drug Administration (FDA) for the approval of drugs and by the best peer-reviewed medical journals for the publication of research reports. Of course, many treatments used in conventional medicine have not been rigorously tested, either, but the scientific community generally acknowledges that this is a failing that needs to be remedied. Many advocates of alternative medicine, in contrast, believe the scientific method is simply not applicable to their remedies. . . .
Alternative medicine also distinguishes itself by an ideology that largely ignores biologic mechanisms, often disparage modern science, and relies on what are purported to be ancient practices and natural remedies (which are seen as somehow being simultaneously more potent and less toxic than conventional medicine). Accordingly, herbs or mixtures of herbs are considered superior to the active compounds isolated in the laboratory. And healing methods such as homeopathy and therapeutic touch are fervently promoted despite not only the lack of good clinical evidence of effectiveness, but the presence of a rationale that violates fundamental scientific laws—surely a circumstance that requires more, rather than less, evidence.
CAM’s rejection of the very basic standards of science is careless and does a disservice to patients by denying them the opportunity of informed choice. The truth is, there is no “alternative” medicine — there is only evidence-based medicine and unproven pseudoscience.
“Do you know what they call alternative medicine that’s been proved to work? Medicine.” — Tim Minchin, Storm.