Here is an opinion piece I wrote for in this week’s Modern Medicine magazine. The version below is the final draft prior to some very minor typographical edits. The article also appears online at irishhealth.com, where you can also read a companion article presenting an opposing perspective on complementary medicine. Modern Medicine is published by Medmedia Publications and edited by Ken Fitzsimons.
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Last year saw the death from cancer of Steve Jobs, the entrepreneur who brought us the iPhone, a visionary credited with enhancing the lives of millions through insight and intellectual brilliance. Nonetheless, although acclaimed as a technological sophisticate, Jobs had a proclivity for the esoteric. When diagnosed with pancreatic cancer, he chose to eschew ordinary medicine and instead turned to complementary and alternative medicine (or CAM). His therapies included dietary treatments, “hydrotherapy”, acupuncture, naturopathy, and even the occasional visit to a psychic.
Many pancreatic cancers are aggressive. Ironically, Jobs had a rare form (an islet cell neuroendocrine tumour) for which ordinary medical treatments offer excellent survival rates. But by confining himself to CAM, he did not see much benefit. Instead, his tumour progressed inexorably to dangerous levels. He then had a poignant change of heart and underwent radical mainstream treatment, including pancreatoduodenectomy and a liver transplant. But it was too late. He died in October 2011, aged 56.
Steve Jobs was by no means the first famous figure to find CAM a poor substitute for ordinary medicine. Readers might remember Peter Sellers, the British actor made famous as Inspector Clouseau in the Pink Panther movies. At the age of 40, Sellers suffered a myocardial infarction that permanently damaged his heart. Ignoring advice to undergo bypass surgery, he instead visited “psychic” surgeons on a regular basis. He died in 1980, aged 54, all too predictably from a massive heart attack.
Or how about Barry Sheene? A World Champion motorcycle racer, Sheene was a boyhood hero of mine. Watching him angle his way at high speeds through dangerous bends, I felt he could defy death itself. Indeed, one of his claims to fame was having recovered so quickly from a bone-shattering crash in Daytona as to be back racing within seven weeks. In later life, Sheene was diagnosed with throat and stomach cancer. But he rejected chemotherapy. “I believe I can beat this thing with natural therapy,” he insisted, before embarking on a therapeutic diet and complementary microwaves treatment. He was dead within months.
CAM uptake is not confined to celebrities. While statistics vary, consumer organisations and public health bodies advise that a very large portion of society, perhaps even the majority, have at one time or another turned to CAM. Usually, such treatments are marketed as being “safe” or “organic” or “pure”, but in reality a very simple principle applies to all therapeutic endeavours. Any treatment that purports to change the functioning of the human body will certainly carry some risk of adverse side-effects; if a procedure genuinely has no side-effects at all it will be because it is doing nothing to change any element of how your body is affected by illness.
In the main, consumers (and sometimes medical professionals) believe that at least some CAM therapies have been shown to be efficacious. However, this is not the case. For most CAM treatments research on efficacy is practically non-existent, while for the more common approaches (such as acupuncture, chiropractic, and homoeopathy) the jury is still very much out. Indeed, this is what makes such treatments “complementary” or “alternative” in the first place: despite thousands of published studies, there is still no firm biological evidence to support their claims to be “medicinal” in the mainstream sense of the term.
Obviously, CAM is extremely dangerous when it discourages people with life-threatening illnesses from receiving proper treatment. As well as celebrity cases, coroners have dealt with a multitude of ordinary citizens who have met similarly tragic ends. I think even the most ardent CAM proponent would agree that advocating CAM for terminal illness is both reckless and immoral (but nonetheless, it continues to happen).
But what’s so wrong about recommending CAM for minor illnesses or symptoms, or as a fall-back for when ordinary medicine has no effective solution (such as in many cases of chronic pain)?
Well, apart from wasting money and time, and raising false hopes for a “cure”, the widespread pushing of CAM is akin to the active promotion of scientific illiteracy and the nullification of consumer scepticism. And this certainly does come with costs, what some social scientists call “the costs of misinformation”.
CAM treatments have failed their scientific road-tests. When CAM proponents tell consumers that this doesn’t matter, they are indirectly encouraging people to be suspicious of evidence-based arguments of all kinds. It is little different from urging citizens to reject the evidentiary case on climate change or the historical evidence for the Holocaust.
Commentators sometimes accuse science and scientists of “arrogance”. However, I can think of few claims more arrogant than that of CAM proponents who assert that their particular experiences, anecdotes, and personal judgements are more valuable than information that is accumulated objectively.
If evidence doesn’t matter, then what does?
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>> Click HERE to read the full debate at IRISHHEALTH.com, including the counterpoint article from a complementary medicine advocate…
Brian Hughes is an academic psychologist and university professor in Galway, Ireland, specialising in stress, health, and the application of psychology to social issues. He writes widely on the psychology of empiricism and of empirically disputable claims, especially as they pertain to science, health, medicine, and politics.
CAM proponents likened to Holocaust deniers – really? I agree with most of your points but that’s a bit much.
Also, what about the benefits of the placebo effect?
The opposing article makes some good points as well, http://www.irishhealth.com/article.html?id=20328&artid=20328, e.g. the role of food in health, the benefits of considering the whole body over isolated symptoms.
The ideal of course would be the methods of mainstream medicine combined with the patient empowerment and health awareness often found in those who use CAM.
I take your point regarding the Holocaust denial sentence. I was trying to make a point about the erosion of critical thinking and scientific reasoning, and its adverse impact on society and culture as a whole, but perhaps I didn’t have enough space to make it properly. The juxtaposition may have ended up a little too squeezed.
I do think there is a point to be made though. Part of the effect of promoting a skepticism of mainstream scientific standards (e.g., regarding medicine) is that audiences are being encouraged to distrust evidence-based knowledge more generally (e.g., regarding culture, politics, and history).
The issue then is whether such costs are outweighed by the potential benefits, such as the ones you mention.
I think it’s right, in principle, that the same sort of problem with accepting, analysing, critiquing and putting into context of the evidence occurs with climate change deniers, holocaust deniers and CAM proponents.
I definitely agree with the communication stuff, though I certainly wouldn’t call what CAM practitioners do ‘patient empowerment’ or ‘health awareness’.
If anything the selling of unproven or ineffective remedies removes the ability of the patient to make an informed choice, therefore disempowering the patient and contributing towards unawareness. CAM practitioners themselves are sometimes unaware of, and usually against or at least not supportive of, more suitable or effective treatment choices. They often tend to be found offering nonsensical mechanisms of action, with no knowledge of any biology, pharmacology, pathology, chemistry or physics (minimal knowledge of these subjects rules out homeopathy entirely for example).
They also tend to fail raise health awareness issues (such as the Simon Singh sting, which found homeopath’s failed to mention even basic ‘holistic’ advice such as to use mosquito nets on holidays where malaria is a risk, information that doctors in that investigation provided) and be against some very important public health services, such as the immunisation program. Certainly though the confidence, listening and communication skills, the quick simple answers that lay people can more easily relate too, the far greater time spent with the patient and the promise of a quick and easy cure, which is safe, rather than the complicated and not always quite so positive reality can contribute towards giving the patient a false sense of empowerment. Which is unfortunate.
I should clarify – when I said “those who use CAM”, I meant the patients/people themselves, NOT the therapists.
I’ve read that one of the biggest user groups of CAM is educated, middle class women – people who have a lot of awareness around health and are proactive in managing it. This group of people should in theory be ideally placed to have good general health and good outcomes. Unfortunately they can be seduced by alternative therapies when mainstream medicine seems to have failed.
Greater understanding of how medicine works (through better doctor and media communication) would be beneficial to this (influential) group.
Yes, I agree. That’s why I think science communication is so important; if people have all the facts they can make informed decisions.
I do think medicine and doctors need to communicate better though. And media has a responsibility for accurate reporting. (Blogs like this one are a good resource for analysis of media coverage.)
I agree regarding communication and think that it is the main reason people turn to complimentary medicine. CAM practitioners spend time with patients, let them feel like they care and come up with a plan (however ineffective it may turn out to be) to treat their ailments. Some doctors especially those running between patients in hospitals/clinics barely look up from their notes. Improved bedside manner is needed. Patients must understand their choices and be given reassurance that they’re in the best hands.
Like many other tricky concepts, if people do not understand the basis of a treatment, therapy, or theory, they tend to reject it, or simplify it into something easier to figure out. Unfortunately many of the simpler ideas are corruptions of the original meaning, or just plain wrong. When it comes to chemotherapy, many simplify it to “poisons/toxin to kill a poison”. But Chemo only poisons rapidly growing cells and as cancer cells grow rapidly, they get killed first. Unfortunately some other healthy cells die too, hair being the most commonly seen. Many people believe the myth that chemo and radiotherapy are killing their loved ones, rather than the cancer it kills, silently and invisibly. What’s worse is that sites like this one: http://www.mumsnothavingchemo.com (profiled in the Sunday Times) promote the idea of ‘alternative’ rather than complementary medicine. There is no reliable alternative to scientific/medical research and it’s also insulting to the medical and research professions to suggest there is. Complementary therapy is great, but you still have to complement a proven therapy.
Conventional, alternative or complementary is as per see. A person who prefers, let’s say homeopathic medicine, as a first line of treatment, conventional medicine is an complementary/alternative for him/her. Likewise a person who took conventional medicine as first line of treatment, other forms of treatment are complementary/alternative.
Usual diatribe – list out a few cases where interventions failed then blame the intervention in a manner such as to claim that conventional medicine works 100%… it is not nor has it ever been.
Then the claim that it is a lack of evidence that makes such treatments ‘complementary’ or ‘alternative’ in the first place, in a manner again such as to claim that conventional medicine is 100% evidence based. Again conventional medicine is far from evidence based.
This then followed closely by the assertion that if conventional medicine doesn’t’ work then that’s it show over – don’t bother trying anything else – it won’t work.
And best of all – all this from a proponent of the pseudo science religion of psychology LOL
One of the common philosophies in alternative medicine is to use treatments that aid, facilitate and strengthen the body’s innate healing processes in their efforts to restore health and balance. To work with, rather than against, the self-evident innate healing process, whenever possible, makes sense and has demonstrated countless successes.`
Hottest write-up on our own webpage
<'http://www.healthmedicinelab.com/jaw-pain-one-side/