Alternative Medicine

A Critique by Philip Longman

First, some background. There are many branches of the "healing arts". Healers range
from shamans to transplant surgeons, over hundreds of cultures and thousands of years.
The group commonly known as "physicians" in the United States belong largely to the
allopathic tradition (osteopathic physicians are a related but distinct group). Our training
is heavily influenced by reforms introduced in the early 20th century by Sir William
Osler and by the "Flexner Report". Prior to that time allopathic medicine used a large
variety of "patent medicines" analogous to the "herbal remedies" of today. These were
concoctions of dubious value and frequent toxicity, which were heavily marketed for
"fatigue, malaise, fever, cold, sore joints ...", etc. (Obesity was much less of an issue back
then.)
Osler, Flexner, and many others brought science to the practice of medicine. The number
of medicines used by well trained physicians shrank dramatically by 1920 -- from
thousands of remedies to a tiny number of effective medicines. Then, slowly at first, new
remedies were developed, tested, and added to the "pharmacopeia". Some of these came
from herbal remedies (quinine), others were developed without known precedent. The
1940s brought the first widely effective antibiotics (penicillins), the 50s and 60s a large
variety of medicines to control blood pressure, treat heart disease, and manage
inflammation. This explosive growth has slowed somewhat in the past decade, but we
now again have a very large pharmacopeia -- based largely on scientific principles.
The quality of medical science has also increased dramatically. Most of the studies
performed in the 1960s would be unpublishable today; their quality would be judged
unacceptably low. A wide range of early therapies were accepted on dubious evidence,
and later painfully found to be harmful or ineffective (Thalidomide, gastric freezing,
mammary artery ligation are all famous examples). More recently "evidence based
medicine" has tested and found wanting many traditional medical practices, such as much
of what was once called a "complete physical". I'm most proud of scientific medicine's
willingness to slay its own "sacred cows", and to abandon cherished beliefs and set aside
millions of dollars of research. When herbal medicine authorities likewise pronounce a
popular herbal remedy worthless or toxic, then I'll be willing to look at the research they
produce.
Scientific evidence in medicine is often very difficult to gather. We can't ethically study
people the same way we study neutrons or fish. We gather some information from studies
of "natural experiments" -- the relationship of selenium to cancer, for example. Our best
evidence, however, comes from very expensive studies where a treatment and a placebo
are given randomly to patients without either patient or physician knowing which is
which. From those studies we've learned that a placebo alone, which is believed to have
no biological activity, will improve many conditions by at least a third. (Example: reduce
pain by 30% or more.)
From scientific studies of health and disease, we've confirmed the power of the mind-
body connection. In some conditions, a person's belief can dramatically eliminate their
symptoms (some fatigue, some pain conditions, warts). In others belief is important, but
more limited (cancer, fractures, bacterial infections).
That's the tradition I come from. Other allopathic physicians hold less strongly to
scientific methodology as a standard of proof, and are willing to accept other evidence,
including "folk evidence", as proof. I feel folk evidence can suggest important areas for
research, but, unless I am confident there's no possibility of harm, I cannot use it as a
basis for treating patients. Chicken soup is OK, decongestants are usually acceptable, the
herbal remedy of the minute is an unknown. If I know a "treatment" is safe and harmless,
and I know a patient believes in it, then I can support its use -- I know the true power of
the mind-body connection.
We know, however, from a hundred years of experience, that popular perceptions of
effectiveness are very unreliable. Individual physician's perceptions of effectiveness are
equally unreliable. Hundreds of popular remedies have been found, on careful study, to
be ineffective or even harmful. Most of the medicines we used to treat a kind of bad heart
rhythm during the 1970s and 1980s have been found to be dangerous and ineffective.
Many heart specialists and patients believed very strongly that those were good
medicines. It took a lot of time and money to prove otherwise.
Herbal remedies and many folk remedies have not survived even the weak scientific
testing that researchers used in the 1920s, much less today's standards of study. If and
when they do, they stop being alternative medicines and become part of our scientific
therapies.
If all of today's "alternative medicines" were completely inactive, their widespread use
would be only a modest problem. If a person believes in a remedy, and if that remedy is
truly harmless, then using it will improve most conditions by about a third, and clear
some up completely.
Unfortunately, we have reason to believe that they're not all inactive. Plants produce a
wide variety of complex chemicals that mimic substances use by our own bodies. Many
powerful medicines, poisons, and hallucinogens have been derived from plants.
Evolution seems to have a somewhat limited range of designs, and tends to reuse
molecular shapes in different species for different purposes. These substances have every
imagineable effect, from hallucinations to sedation, from quick death violent vomiting.
Today's herbal remedies are not likely to have obvious seriously harmful effects. Even
though they're largelyunregulated and largely untested, that kind of obvious harm would
get publicity. Obvious harm is more likely to come to people with unusual sensitivities, or
when a herbal medicine taken in unusual combinations with allopathic medications or
other herbal remedies. More subtle problems, such as birth defects, neurologic damage,
and cancer, will be much harder to spot.
We just don't know what these substances are doing. They may be inactive, or they may
have activity independent of their powerful belief effect. Their activity may match up
with one of their advertised uses, or they may be effective for something completely
different. They may be harmful in subtle or unsual ways. Toxic or beneficial effects will
vary greatly from dose to dose; unmodified plant products do not have even the limited
predictability of "traditional" medicines.