Saturday, 17 January 2015

Nostrum for all ills

Total Bollocks

What is it about the word ‘alternative’ that lends undue respectability to the words that follow? For example we have ‘Alternative Energy’, ‘Alternative Lifestyle’ and of course, ‘Alternative Medicine’. The word ‘alternative’ confers a patina of respectability to concepts that are often found wanting if only we are prepared to probe a bit deeper.

Many of us are critical of modern medicine and rightly so. Medicine is an evolving science and has yet to find cures and effective treatments for many common and often fatal diseases. And this is where ‘Alternative Medicine’ enters the fray. In fact the term ‘Alternative Medicine’ covers a whole host of so called ‘therapies’ from the down right bizarre and silly (yes homoeopathy, I’m talking about you) through to treatments which have acquired a certain degree of prestige, such as acupuncture; even conventional medical practitioners have become seduced.  And let us not forget the financial incentives. Alternative medicine is a big and largely unregulated business. It is estimated that in the US alone consumers spend 34 billion dollars annually on alternative therapies. Unscrupulous individuals are making a lot of money as ‘practitioners’. Undoubtedly there are those who are sincere and believe in the effectiveness of their therapies. Equally, there are those who are utter charlatans whose main concern is the fleecing of the gullible and desperate.

Adherents of alternative therapies often claim astonishing results for their respective treatments. Beware of ‘cure all’ therapies. Panaceas for all our ills do not exist; this applies to both conventional medicine and the alternative variety. Modern medicine is founded on sound scientific principles and is subject to the rigours and self righting mechanism of the scientific experimental method. This of course reflects the world of perfection, which has never existed, but at least medicine is well intentioned, and although progress is sometimes faltering, it is inexorably forward. This is not the case with alternative therapies. Indeed they often revel in their unconventional non-scientific approach. Or if they attempt to explain their mechanisms they invoke non conventional ‘science’ or weird esoteric principles beyond the reach of scientific scrutiny. And really, this is the important point: Modern medicine is based on the double blind clinical trial. To judge a treatment effective, or not as the case may be, it needs to evaluated in a medical trial with a suitably selected control group. The results are then published in a scientifically respected and peer reviewed journal. The process is not fast but is designed to weed out effective from the non-effective drugs, procedures and treatments. In contrast, most practitioners of the alternative usually have little time for rigorous procedure. When they claim ‘data’ supporting the effectiveness of their nostrums it is mostly in the form of personal testimony (not worth the paper it is not printed on). In other words, patients report that the treatment is effective. Here is the problem: How are we to judge a treatments true effectiveness? Sometimes disorders get better regardless of intervention; people exaggerate with respect to their illness and possible cure. Others are not really ill at all; people lie. The placebo effect is a real phenomenon. If we think a treatment is going to be effective then that may well be the case, irrespective of medical worth. The only way to distinguish between these possibilities and uncover a treatments true value is by well established medical and scientific principles.

But surely I hear you say: ‘Not all the so called alternative therapies should be judged together. Granted there some that are plain daft, but others such as acupuncture, are actually very effective for certain conditions’. A fair point. Of all the so called alternative therapies, acupuncture has received more than its fair share of scientific evaluation. It has some of the hallmarks of an effective treatment. It is an ancient practice (must be worthy then?) and a degree of physical intervention is involved; needles are inserted and stimulated, either manually or by electric current. It also has its own ‘pseudo-scientific’ principles. I don’t want to go into too much detail about the proposed rationale for its effectiveness, so I’ll briefly summarise: Practitioners believe that by inserting needles at specific node points (define please), the needles influence the body’s natural energy channels (Chi- nice word, but what does it actually mean?). Whilst this is the basis for a hypothesis it has not been borne up by scientific evidence. Of course, this doesn’t mean that the treatment is ineffective. It could simply mean that the proposed mechanism of action is wrong. So what do the studies show? As far as I’m aware, and I am more than happy to be contradicted, the only sound scientific evidence for the efficacy of acupuncture, for anything, has been for the management of pain; that’s it. Moreover, it is no more effective than conventional analgesic drugs. I don’t know about you, but I’d rather take morphine or even Panadol. Other claims for acupuncture, as a treatment, are anecdotal and therefore completely worthless as evidence. To convince me otherwise I will require a reference to an article outlining a well designed and executed trial published in an established and respected scientific or medical journal.

I suppose we all want and yearn for quick fixes in life. This applies to many things from our money woes through to our health, and yes, it pays to be questioning and prudent in all things (this person does not exist). In some ways bad decisions in many of life’s activities have no long acting effects on our ultimate well being. Bad decisions with regard to our medical conditions can, and do, have catastrophic consequences. Steve Jobs, the highly talented and mega rich co- founder of Apple died in 2011 of pancreatic cancer. No surprise there. Pancreatic cancer is associated with a particularly poor prognosis. It is an aggressive disease and usually diagnosed when advanced. Once the disease has spread to other sites (metastasised) an early death is inevitable. Consequently, less than 1% of sufferers survive 5yrs post diagnosis. Not even the wealthy can circumvent medical reality. However, this is not quite true in Job’s case. Most pancreatic cancers are nasty adenocarcinomas. Jobs had a rare form of pancreatic cancer (islet cell neuroendocrine tumour) which is associated with a favourable prognosis and is very amenable to early treatment. It is estimated that between 80 to 90 percent of patients will still be around after 10 years-if treated. Jobs decided to eschew conventional medical treatment and opt for a treatment regime based on diet, herbs, acupuncture and spiritual consultation (God help us all!). After 9 months of ineffective ‘treatments’ he elected for surgery. By this time his tumour had spread and extensive surgery was therefore necessary.

Steve Jobs was an intelligent, demanding, egomaniacal perfectionist who also happened to be a Buddhist. He placed his faith in unconventional treatments of dubious provenance when he should have been undergoing effective, conventional, medical treatments which would have saved his life. The irony of course, is that the character traits which served him so well in his creative and business life failed him at the last, much to the exasperation of his family and doctors. I suspect, towards the end, Steve Jobs realised his folly, but by then no amount of chanting or chemotherapy could have saved his life.

There is no such thing as alternative medicine, just medicine.

No comment


  1. The only experience of alternative remedies I have is Acupuncture, my partner broke his back a little over 3 years ago and had chronic pain even after his bones healed.
    He had acupuncture and it made a huge difference to his abilities to walk and move pain free, all he had was 6 sessions.
    Now he has a TENS machine and any time he has a flare up he uses that and the pain goes away.
    Now whether, it psychosomatic or not I have no idea, but I do know the pain was real, and I do know it improved.
    He also has some experience of CBT (cognitive behavioural therapy) which made some improvement to his anxieties. But basically the only things that improves all his psychological issues is anti psychosis meds and even they don't take all the symptoms away.
    As for all the others I have no clue as to effectiveness and can only speak as I find, there are no quick fixes.
    My partner was convinced that his back pain was the end and that he would eventually be paralysed and wheelchair bound the acupuncture completely change things for him.

  2. Your experience is interesting. My GP is very pro acupuncture and suggested that my wife undergo a course for her chronic ailments. We then proceeded to have an interesting discussion. Of all the so called 'alternative therapies' acupuncture shows some promise, but the data and the claims by its adherents, are divergent. Individual experiences represent anecdotal evidence. That is why we need double blind and well thought out studies to truly examine the effectiveness of any treatment or drug. Clearly, acupuncture can help with pain management but as far as my research shows, there is no data supporting its effectiveness for anything else. Of course there is the placebo effect, which is real and can have a valid impact on health. Kath, I suspect I'm a die hard old rationalist and due to my training I tend to place the cold hard beam of reason on everything. Not much wiggle room for faith or emotionalism. My wife thinks I'm mad, but continues to love me, regardless.

  3. I do feel, however, that there is such a thing as 'alternative reality' and sometimes that I am living in it...