Jul 28 2009
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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