Monday, November 25, 2013

Alternative Medicine: How much trust does it deserve?

Alternative medicine is a topic that many people are very passionate about because it has this connotation that it is the more natural or pure way of treating the body, bringing it back into balance. Some people feel that there is almost a spiritual nature to it. On the contrary, "evidence based medicine", or "western medicine", is sometimes seen in a very suspect way because of the huge amount of money that is involved and the synthetic nature of many of the pharmacological treatments. While alternative medical treatments have helped many people it can receive more trust than it deserves putting people at great risk of rejecting life saving and quality of life improving treatments. For this reason I would like to point out a few things about these two types of medicine.

Alternative medicine isn't shown to work while evidence based medicine is. 

By definition Alternative medicine is any practice that is put forward as having the healing effects of medicine but is not based on evidence gathered using the scientific method. This definition of alternative medicine doesn't necessarily mean that it never works, it just means that it hasn't been proven to work using the scientific method under reasonable experimental conditions. It also points out the fact that there are some alternative medications that are used which have been scientifically proven not to work, which is a problem.

Evidence based medicine on the other hand is medicine that has been proven to work using the scientific method. These studies have been peer reviewed and the results of the study accepted with high statistical confidence within the community of the medical specialty.

More simply stated by Tim Minchin:
"Alternative medicine, by definition, has either not been proven to work, or proven not to work. Do you know what they call alternative medicine that has been proven to work? Medicine."
-Tim Minchin
Using these definitions it means that once any substance or method has been proven to work under reasonable scientific experimental conditions it automatically becomes evidence based medicine and ceases to be alternative. Ideally whenever a new treatment is shown to work with a high level of confidence it would instantly be implemented into our health care system but this is not always the case for many different reasons good and bad.

Alternative medicine is not regulated while evidence based medicine is. 

The FDA (Food and Drug Administration) was initially set up in 1906 for the purpose of keeping people safe. One of their jobs is the regulation of medical drugs. In order for a drug  to claim it works as a treatment of a specific pathology it needs to have been shown to be safe and effective (benefits outweigh risks). Once approved the FDA monitors the manufacturing process of the substance, labeling and advertising. Each drug has a known toxic dose and effective dose based on studies to ensure it is safe. Even after the drug is released it is monitored to ensure there isn't any long term negative effects.

Dietary supplements, being a large bulk of alternative medicine, is not regulated because in 1994 they were mandated to be regulated as foods rather than drugs under the Dietary Supplement Health and Education Act. Therefore they are not subject to safety and efficacy testing and they have no approval requirements. They are not allowed to state on the label that they specifically treat, diagnose or cure any illness and must include a disclaimer on the label.  A 2013 study that looked at 44 different herbal products from 12 different companies showed that:
"Most (59%) of the products tested contained DNA barcodes from plant species not listed on the labels. Product substitution occurred in 30/44 of the products tested and only 2/12 companies had products without any substitution,contamination or fillers. Some of the contaminants we found to pose serious health risks to consumers". 
"Most of the herbal products tested were of poor quality, including considerable product substitution contamination and use of fillers"
So the majority of the time when you are taking dietary supplements what is stated on the bottle isn't necessarily what is in the bottle. Often times the labeling on dietary supplement adds and labels give the notion that they cure specific problems without specifically stating that they do, which is very confusing to consumers.

Alternative medicine usually isn't based on sound scientific principles.

Most forms of medicine that fall under the realm of alternative medicine are based on unsound principles. For example:

Homeopathic Medicine, developed in 1796, is based on the principle that "like cures like", meaning that the substance that caused the disease in a healthy person will cure similar symptoms in a sick person. These remedies are prepared by repeatedly diluting a substance in alcohol or distilled water to a point where none of the original substance remains. In essence you are only receiving water and any positive affect that you are receiving is due to the placebo affect.  A current example of the damaging affects of homeopathic medication include Nosodes, which are homeopathic (diluted down to only water) vaccines that claim to protect people against disease like a normal vaccine.

Traditional Chinese Medicine is not based on any internal anatomy. It was against the law to perform autopsies in China until 1912 and because of this the Chinese had no system of anatomy comparable to western medicine.

Use of alternative medications is often supported by logical errors. 

The idea that just because it is natural it is good is incorrect. While it may appear that pharmaceutical drugs are more of a risk because they are required to list all of the known side effects, natural herbs and other substances have side effects  as well (click the link, I dare ya). These side effects are less understood because they haven't been as thoroughly tested. The consumer is less aware of these side effects because they are not required to release or obtain this information. All substances are toxic to the body at some level, even water. The problem with herbal supplements is that this toxic dose is not always known while with regulated drugs it is required knowledge.

Anecdotal studies and case studies are not adequate scientific proof. There are some very compelling documentaries out there that give the story of only a single person or a few people who benefit from a specific treatment. This is not adequate. There are many types of studies and each type provides a certain level of evidence and until an out come is statistically significant under scientific conditions it isn't proven. Case studies and anecdotal treatments are the starting point of investigation.

Just because something has been used for a long time doesn't mean it works. A common rational for supporting alternative medicine, such as eastern type medicine, is the fact that many methods have been used for thousands of years. This is not always true and could be attributed to a correlation vs causation fallacy. How many years did the native Americans perform rain dances?  The average life expectancy in China in 1960 was only 36.3 yrs while in the United States it was 69.8 yrs. Sam Harris put it well when he stated:
"But the mere endurance of a belief system or custom does not suggest that it is adaptive, much less wise. It merely suggests that it hasn't led directly to the society's collapse or killed its practitioners outright."
-Sam Harris, The Moral Landscape

  1. I do not consider healthy eating or a healthy life style to be alternative medicine. All people should do their best to eat healthy and stay active in an attempt to prevent problems down the road.
  2. Also, I am in no way claiming that evidence based medicine is perfect or that it has all the answers. There are still a lot of unanswered questions that need to be looked at. With time and the use of the scientific method, evidence based medicine will continue to improve. 
  3. Evidence based medicine is not biased towards where it obtains its treatments, specific health care systems maybe but that is different. As long as something can be shown to work under reasonable scientific experimental conditions beyond that of current treatments available, whatever the source of the information, be it China or fresh vegetables, it is then considered evidence based. 
  4. Testing any hypothesis, takes time and money and I do agree that pharmaceutical companies have a lot of money which allows them to actually test their products.  Numbers probably have been fudged by dishonest companies on rare instances but I personally trust this process of medicine being shown to work over the alternative. 
  5. The burden of proof is on these alternative medicines to do high level studies that show with high confidence that their treatments repeatedly work. Until then they will remain under the umbrella of Alternative Medicines. 
A few words from Michael Specter on the matter: