Comments on alternative medicine

The Skeptic is a quarterly magazine that has been in existence since 1987.  Published from Manchester, it seeks to examine paranormal claims of all types with a scientific eye.  Skepticism means inquiry, not being negative simply for the sake of being negative.  Above all, skeptics seek to examine the evidence for a claim and to test its truth.

Alternative medicine is a subject of great concern to us, as people are exceptionally vulnerable to false claims where health is at stake. Orthodox medicine in our time has many problems:  traditional research has been shown to have glossed over gender differences in testing treatments; doctors resources are so overstressed that they have little time and attention to give their patients; and our medical schools train personnel to be technicians first and humans barely at all.  The upshot is a widespread dissatisfaction with many aspects of both the health service in specific and medicine in general.  Many medical treatments are frightening and onerous, and there are not always guarantees of success.  Is it any wonder that so many people are therefore attracted to the apparently kinder, gentler world of alternative medicine, in which the treatments are generally harmless or even soothing, the practitioners able to give time and attention to patients, and the flattering notion that "we treat the whole person, not just the disease" holds sway?

Nonetheless, we believe that these treatments, most unproven or lacking in efficacy as most of them are, are not the way to improve medicine. Giving people access to homeopathy, acupuncture, faith healing, and aromatherapy may appear to bolster consumer choice, but better preventive medicine would make far more difference in the long run, both to the general state of health in the UK and to the costs of managing the health service. 

There follow specific points in answer to the questions raised in the request for comments.

1.  Evidence.  It is a central plank of skepticism that the scientific method is the basis of sound research:  the edifice of human knowledge is built brick by brick using the techniques of independent verification of experiments.  While it is doubtless difficult to design properly controlled experiments for certain types of alternative therapies, it seems to us that substantial evidence must form the basis of any widespread acceptance of therapies that are going to be paid for out of the public purse.  It would be a profound rejection of all we've learned to return to an era in which superstition and pseudoscience ruled medical treatment.  The fact that something is popular does not make it an effective or valuable treatment.

2.  Information.  It is extremely unlikely  and not just because of the development of the Internet  that any country will be able to control the quality or availability of information about either alternative or orthodox treatments.  My personal specialty as a journalist is covering the Internet and its social and cultural ramifications for publications like the Daily Telegraph and Scientific American, and in my eight and a half years online I can say with absolute certainty that attempts to suppress information have never worked.  Trying to control what people read will simply give the information enhanced desirability  and even credibility, if people can convince themselves (as they will) that alternative medicine is under attack because the orthodox medical establishment is afraid of the erosion of their power base.  (There have been situations in the past, such as the debate over licensing midwives, in which the medical establishment has seemed to behave in precisely this way, so the charge cannot be completely dismissed.)  It seems to me that the best antidote to bad speech is more speech.  The NHS, the university medical faculties, and the government would do well to join together to create good and useful sources of online and offline information that distressed patients can consult when they are looking for answers.  Studies have shown that many patients have difficulty, particularly right after receiving shocking news, in understanding what their doctors tell them.  Being able to refer people to an authoritative source appropriate to the UK would help many of these people by allowing them to absorb the information they need at a pace that's appropriate for them.  If there are treatments out there that are understood to be dangerous, the best solution is to make information available explaining why they are dangerous and what research exists to bolster that view. It is inevitable that at least some people with frightening illnesses will do their own research to find out whether there are alternatives to what their doctors are recommending; I would do this myself.  The culture of medicine will have to learn to accept this. 

3.  Research.  I personally would rather see the limited funds available for research spent on treatments that have a chance of working.  It seems to me a waste of funds to research treatments whose claimed efficacy (I'm thinking of homeopathy in particular) depends on a complete contradiction of all the science we have unless there is extremely strong evidence that the treatments work beyond the usual placebo effect.  It is very important in all such research that standard for what is failure or success are agreed at the outset, along with the research protocols, so that in the event of negative results those promoting the therapy being tested are unable to claim that the test was invalid.

4.  Training.  Medical personnel who are going to deal with people who may have used or be interested in one or more of the so-called complementary therapies of necessity must know at least something about what they are and how they work (or don't work).  Especially, medical students need to learn how to critically evaluate unfamiliar therapies and evidence.  In addition, it is important to training medical personnel to communicate more effectively with patients and to understand their needs as human beings; doing so would make a profound difference to most peoples experience of medicine (and make questionable therapies less appealing). 

5.  Regulation and risk.  Many alternative therapies are essentially harmless as long as they do not become substitutes for orthodox medicine that works (for example, a woman with early-stage breast cancer would be ill-advised to see a homeopath rather than a medical doctor).  There are a few that do present concerns.  Both acupuncture and the completely fraudulent practice of "psychic surgery" break the skin of patients; hygiene is an issue with these.  Herbalism's reliance on older "more natural" versions of today's refined drugs also poses potential dangers.  I personally would be opposed to licensing schemes for harmless but useless treatments that gave those treatments more credibility.

6.  NHS provision.  The most important element common to alternative therapies that should be incorporated into the health service is the time and attention given to customers/patients.  With stories of closing wards and poor hospital hygiene filling the newspapers, it is depressing to think that the NHS might consider instead spending its limited funds on treatments that are comforting but useless in the name of consumer choice.  While no one wants to see the NHS's mind closed to new treatments that have merit, its more important to see basic, established principles carried out in practice first.  An additional major concern is what will happen in situations when alternative/complementary therapies are cheaper than the orthodox ones: are people going to be directed to try the cheapest remedies first? There are of course situations where there are inexpensive "home" remedies that do work  but these are not usually the remedies promoted by complementary practitioners.  Skeptics groups in the Netherlands and Germany say, however, that self-regulation has led to dramatic abuses by alternative medicine practitioners, and we can provide contacts for more information in this area.