Jul 28 2009

Common CAM Media Myths

So-called complementary and alternative medicine (CAM) – or what I think is best characterized as non-science-based medicine, is a common subject for the lay press. It’s counter-cultural, controversial, and can easily incorporate elements of fear and self-empowerment – all themes the media loves.

Articles on CAM often contain the same “facts”, whether quoted from some perceived expert or just asserted by the author, that in fact are wrong or grossly misleading. In an interview with the SGU, Christopher Hitchens commented that lazy journalists simply tell the story that is being told and then they build the “facts” around that story – rather than investigating to determine what the story actually is. This is very true in the world of CAM reporting.

Take this recent article from syracuse.com. Actually, I will say right off that the author gets many things right. I am always pleasantly surprised to see reasonable comments in these pieces. Perhaps we are starting to get through. So let me start with some praise for those points I was happy to see.

“The key question shouldn’t be, ‘Is this a traditional medicine my insurance plan will pay for or it this complementary?’” said Dr. Lisa Kaufmann, a University Hospital internist. “The real question is, ‘Does it work?’”

That is absolutely the real question – everything else is an elaborate diversion – the flourishes and exaggerated movements of a stage magician meant to distract the audience from his or her slight-of-hand.

Of course, answering this question is often challenging, and proponents of treatments that do not work spend a great deal of time and effort trying to create the false impression that they do. But at least occasionally we can see the proper focus on the true question, does it work (and also, is it safe – or more accurately, do the benefits outweigh the risks).

Terms such as “Western” medicine, “integrative” medicine, holistic, natural, etc. are all meaningless diversions from the real question that should concern a health care consumer – the safety and efficacy of the proposed intervention. (I say “real” and not “only” because questions of convenience and cost are legitimate, just separate from the question of effectiveness).

There is also this gem from Kaufman:

Kaufmann said there’s a common misperception that all herbal medications are safe. “Herbs are quite often potent pharmaceuticals,” she said. Many of them have side effects and risks just like prescription drugs.

That’s right – herbs are drugs. It’s as if Kaufmann has been reading this blog. Actually, this is a reality that should be obvious to any medically trained person, so I hardly need to take credit for this realization. Kaufmann adds that patients should tell their physicians about their use of herbs and supplements. Very true.

But unfortunately that is where the goodness ends and the common CAM propaganda myths begin. The title of the article, in fact, is a bit of CAM propaganda – “More Americans choosing complementary or alternative medicines.” More than what? This is a mantra of the pro-CAM crowd (and reflects a social-norming strategy – basically peer-pressure), but it is not backed by evidence.

I have discussed at length the National Health Interview Survey that shows that very few Americans are using hardcore CAM modalities – like acupuncture, homeopathy, and energy medicine – all in the single digits and not changing significantly. Like the false autism epidemic, that CAM usage is increasingly mainstream is an artifact of definition. If you include things like massage, prayer, taking vitamins, and exercising like yoga, then you can inflate the figures.

The article quotes the highly inflated 40% figure for CAM use – but that figure is meaningless unless you define CAM, which has a slippery definition. By the most liberal definition anyone who has ever prayed for a sick love-one, apparently, has used CAM.

The article also recommends the NCCAM as an objective source of information about CAM. It does not even mention that the NCCAM is controversial in scientific circles, and is actually a political creature, forced on the NIH by senator Tom Harkin. The NCCAM exists to promote CAM, and so far has wasted 2.5 billion dollars of taxpayer money without finding a single effective CAM treatment.

Follow the false balance approach, the article next interviews a pro-CAM physician to balance the common sense of Dr. Kaufmann.

Interest is growing in CAM because many people have become disillusioned with the way traditional medicine is practiced, said Dr. Scott Treatman, director of employee health services at Crouse Hospital. He teaches mindful living and stress reduction through SUNY Upstate Medical University and provides acupuncture.

This is a common assertion – but it is simply made up by CAM advocates for propaganda purposes – it is a self-serving assumption without a basis in fact. It is also a question that has been studied, although admittedly not much. But what data we do have tells the opposite story.

This 1998 survey by Astin found that:

Dissatisfaction with conventional medicine did not predict use of alternative medicine. Only 4.4% of those surveyed reported relying primarily on alternative therapies.

Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.

In this more recent survey of CAM use in the elderly – chronic health problems, especially chronic pain, and a desire for control were correlated with CAM use. Dissatisfaction with mainstream medicine was not named.

Other surveys show the same thing – the profile of a CAM user is a person with disposable income who has a chronic painful condition and is ideologically aligned with a more spiritual approach to their health and desires a sense of control over their condition. Dissatisfaction with mainstream medicine does not appear to be a significant factor. But that is the answer I see reported in the media nearly 100% of the time (I cannot remember any counter examples, but I can’t rule them out by memory alone).

That’s just lazy reporting – 10 minutes on the internet reveals that what evidence there is does not support the dissatisfaction claim.

The concept of CAM is completely artificial – it is a manufactured concept without a clear definition that is evolving into a modern myth propagated by a willing or just lazy media. The real story is that the public is being sold a bill of goods – a collection of treatments that are highly implausible and generally do not work.

One approach to marketing is not to market the product but to market something intangible – you’re not selling a car, you’re selling excitement or prestige, or even better – sex. CAM marketing often does not market the treatment itself – because the treatments are implausible and ineffective – they just don’t hold up to scientific scrutiny. So instead they market spirituality, control, and empowerment. And the people who want those things, buy it. They even use the common commercial ploys of the bandwagon phenomenon – everyone is doing it – and trumping up dissatisfaction with existing products.

But just like with that amazing new cleanser or incredibly absorbent towel, a savvy consumer should ask themselves about any specific “CAM” modality – does it really work.

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12 responses so far

12 Responses to “Common CAM Media Myths”

  1. jonny_ehon 28 Jul 2009 at 11:01 am

    In reading your second to last paragraph, I couldn’t help but think about the skepticism movement. How can we learn from CAM’s marketing savvy to promote reason and good science? We obviously can’t just appeal to people’s spiritual side, but maybe we can tap into people’s sense of justice? Where’s Steve Cuno when you need him?

  2. DevoutCatalyston 28 Jul 2009 at 12:22 pm

    “…But just like with that amazing new cleanser or incredibly absorbent towel, a savvy consumer should ask themselves about any specific “CAM” modality – does it really work.”

    The American College of Physicians has a book out claiming to provide these answers,

    http://www.amazon.com/Evidence-Based-Guide-Complementary-Alternative-Medicine/dp/1934465046

    I don’t have the $58 to find out what’s in it, but via the glowing words of the endorsers, I have a hunch I would not be amused.

    So who is the average Joe going to trust, when there are so many authoritive sounding voices in CAM’s court? Hell, I’d rather deal with door to door religious proselytizers, they’re simply less fervent.

  3. Bronze Dogon 28 Jul 2009 at 1:25 pm

    In some ways, this reminds me of McDonald’s. You don’t often see the commercials being about the food. Instead you have a bright, goofy clown surrounded by laughing kids, handing out smiling red “Happy Meals.”

    They’re not selling a product, they’re selling symbols of an emotion.

  4. daijiyobuon 28 Jul 2009 at 4:10 pm

    Per ‘marketing control and empowerment’ [literally] while “they just don’t hold up to scientific scrutiny” [actually],

    just remember, as naturopath Shanni Fox (ND NCNM; that vitalism bastion) tells us, at “Diabetes Health: [motto] Investigate, Inform, Inspire”

    http://www.diabeteshealth.com/read/2009/07/24/6286/naturopathic-physicians-up-and-coming-partners-in-diabetes-care/

    ND sCAM is great for diabetes:

    “what if there were a ‘one-stop shop’ for diabetes management: a licensed medical professional skilled in diagnosis, medication, and nutrition and lifestyle management, as well as patient education? [...] meet the naturopathic physician [...] medical experts [...] With their focus on prevention, attention to each patient’s uniqueness, and empowerment of people to make beneficial choices for themselves, naturopathic physicians are often an excellent choice as partners in diabetes care.”

    On her homepage shared with three other NDs [insightstohealth.net], they state in “FAQs”:

    “most of our treatments have been researched and validated by rigorous scientific studies [par for NCNM, which states nonscience survives scientific scrutiny!].”

    The ND seems to think she’s medical [she's not, she's naturopathic], professional [I don't see NDs living up to that ethos], educating [miseducating], empowering [are falsehoods empowering?], excellent [is it excellent to be WRONG?], and scientific [is vitalism, hugely expertly coded in that article, science?].

    sCAM people are posing as communicators / investigators / informers-educators. Insightful!

    They are posing as media people / journalists — propagandizing.

    Just as they pose as science-experts.

    -r.c.

  5. HHCon 28 Jul 2009 at 11:01 pm

    CAM can help with chronic pain in tandem with Western Medicine. But CAM and Western medicine can also aggravate problems associated with chronic pain. I have succeeded in alleviating this condition because of vigilence over the type of care provided and continuously working and learning with professionals. Its an interactive process, certainly not one for cowards.

  6. Sabioon 28 Jul 2009 at 11:30 pm

    Other surveys show the same thing – the profile of a CAM user is a person with disposable income who has a chronic painful condition and is ideologically aligned with a more spiritual approach to their health and desires a sense of control over their condition.

    I am an ex-acupuncturist & herbalist (Japan licensed) who came to this country in hopes of mixing Western and Eastern medicine when I became a physician assistant. I saw quickly how your above quote is correct. In Japan and China, people went to Acupuncturists to get better, not for the reasons listed above. It was new for me.
    That said, I left these practices because I did not see the effectiveness I expected. Mind you, I saw amazing placebo effects.
    I still don’t know if I think they don’t work for some things, but since I have left the field, I have not kept up on this.
    Thanx for the post.

  7. Dan Royon 29 Jul 2009 at 2:16 am

    @Devout

    From the product description of the oxymoronically named book “The ACP Evidence-Based Guide to Complementary and Alternative Medicine”:
    Here’s the comprehensive, evidence-based analyses physicians need to counsel patients about complementary and alternative medical therapies and to integrate these techniques into their own practices!”

    Jeez. This is a must-read. And I really do wonder what evidence-based CAM modalities they’ve found to be working that the NCCAM hasn’t found yet albeit spending 2,5 billion dollars.

  8. Feboon 29 Jul 2009 at 5:03 am

    @Johnny Eh – If skepticism borrowed CAM’s deceptive marketing tactics, it’s wouldn’t be promoting skepticism, would it? Those tactics depend on people being profoundly unskeptical.

    Actually, come to think of it, Penn & Teller’s Bullshit is probably exactly what you’re looking for — a program that uses incredibly irrational and deceptive arguments to promote positions that are often associated with skepticism.

  9. Sabioon 29 Jul 2009 at 7:55 am

    Over the wire today:
    Alternative medicines seen as gaining acceptance despite government findings
    Article Detroit News .
    Humans are funny, we have to remember, evidence is not everything. (sarcasm)

  10. 1RickDon 29 Jul 2009 at 3:51 pm

    Never underestimate NCCAM – The National Center for Coincidence Anecdote Medicism – who ya gonna believe, the gov’ment or your own eyes . . .

  11. wertyson 30 Jul 2009 at 7:11 pm

    @DevoutCatalyst

    You are exactly right in criticising medical doctors who drink the Kool Aid on their way down the rabbit hole to the wilds of irrational medicine. I have seen it happen repeatedly amongst my colleagues, but thankfully may of them become more disillusioned with starting up sCAM practices than in using treatments that actually work, at least in my experience. It has taken me a long journey from being a rabidly rational high school student to a fairly ‘integrationist’ medical student, to a burnt-out and cynical junior doctor, then a hard-nosed military doctor and finally after a few more peregrinations to being a pain management doc, with my final philosophical position settled as a scientific skeptic.

    I firmly believe that MDs are as human as the rest of the population and I can tell you it feels great when you win over a patient with a bit of woo that seems to work. I imagine a magician must feel the same way. I have actually learnt more psychology from studying amateur magic than I ever did in medical school !

    These medical true believers get into it for complex psychological reasons but in my experience despite the damage they can do, many drift off into shruggie-dom rather than staying complete woo-merchants.

  12. DevoutCatalyston 31 Jul 2009 at 8:46 am

    @wertys

    Doctors are indeed human, and I look kindly upon most of them.

    I’m hoping someone blogging here will buy that ACP book and take it apart and let the rest of us know what’s on the inside. The authors of the book need to experience some sound criticism, if it is warranted, and I suspect it is.

    I was treated by an orthomolecular physician in the 1980s, and am grateful as a patient to the one internist I later saw who stood up and called a quack a quack. Medicine is under siege and it needs to fight back, skillfully, especially in cases where the problem is internal.

    The insidious “medical doctors are clueless” message from the alternative medicine camp has been really quite damaging, the idea of embracing alt med practioners and then integrating them into your standard of care is crazy in the extreme. Actually becoming clueless is not a good defense against the meme than says you are.

    Oh, and to my former orthomolecular doc:

    “I’ve upped my standard of evidence, up yours”. ;*)

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